☰ INDEX
ENT_Surgeries-Previous_Year_Questions
Ear-ASOM_and_CSOM__Complications
Ear-Anatomy_of_External__Middle__and_Internal_Ear
Ear-Cholesteatoma_and_CSOM
Ear-Disorders_of_External_Ear_and_Eustachian_Tube
Ear-Facial_Nerve_and_Acoustic_Neuroma
Ear-Hearing_Rehabilitation__Otalgia__and_Tinnitus
Ear-Meniere_s_Disease_and_Glomus_Tumor
Ear-Middle_Ear_Diseases__ASOM_SOM
Ear-Otosclerosis
Ear-Physiology_and_Assessment_of_Hearing
Ear-Previous_Year_Questions
Ear-Vestibular_System__Physiology__Assessment__and_Associated_Diseases
Instruments-Previous_Year_Questions
Larynx-Laryngeal_Paralysis_and_Laryngeal_Carcinoma
Larynx-Larynx__Anatomy_and_Pathology
Larynx-Previous_Year_Questions
Larynx-Voice_Pathologies_and_Congenital_Lesions_of_Larynx
Miscellaneous-Previous_Year_Questions
Miscellaneous_Topics-Miscellaneous
Miscellaneous_Topics-Previous_Year_Questions
Nose_and_Paranasal_Sinuses-Anatomy_of_Nose_and_Paranasal_Sinuses
Nose_and_Paranasal_Sinuses-Diseases_of_the_External_Nose_and_Septum
Nose_and_Paranasal_Sinuses-Disorders_of_Paranasal_Sinuses
Nose_and_Paranasal_Sinuses-Epistaxis_and_Facial_Trauma
Nose_and_Paranasal_Sinuses-Granulomatous_Lesions__Congenital_Anomalies__and_Nasal_Polyps
Nose_and_Paranasal_Sinuses-Previous_Year_Questions
Nose_and_Paranasal_Sinuses-Rhinitis_and_CSF_Rhinorrhea
Pharynx-Adenoid_and_Palatine_Tonsils
Pharynx-Anatomy_of_Pharynx_and_Pharyngeal_Spaces
Pharynx-JNA_and_Nasopharyngeal_Carcinoma
Pharynx-Ludwig_s_Angina__Pharyngeal_Pouch_and_Abscess_related_to_Pharynx
Pharynx-Previous_Year_Questions
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Adenoidectomy with grommet insertion", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is accountable for causing ear pain following a tonsillectomy procedure among the options provided?", "options": [{"label": "A", "text": "Glossopharyngeal nerve", "correct": true}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Trigeminal nerve", "correct": false}, {"label": "D", "text": "Vagus nerve", "correct": false}], "correct_answer": "A. Glossopharyngeal nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dohlman’s procedure is for:", "options": [{"label": "A", "text": "Meckel’s diverticulum", "correct": false}, {"label": "B", "text": "Zenker’s diverticulum", "correct": true}, {"label": "C", "text": "Bochadlek hernia", "correct": false}, {"label": "D", "text": "Menetrier’s disease", "correct": false}], "correct_answer": "B. Zenker’s diverticulum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PnqvSlLqrVG2lPfu08nl1746705292.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outpouching of <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> through Killian’s dehiscence</strong> (weak area in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharynx)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cricopharyngeal dysfunction</strong> leading to high pressure and <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> formation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Dysphagia</strong></p>\n<p>2. <strong>Regurgitation of undigested food</strong></p>\n<p>3. <strong>Halitosis</strong> (bad breath)</p>\n<p>4. <strong>Aspiration pneumonia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barium swallow X-ray</strong> (shows a <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal pouch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dohlman’s procedure (endoscopic diverticulotomy)</strong></p>\n<p>Open surgery if large</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image below shows a procedure that was done on the patient. What is the procedure?", "options": [{"label": "A", "text": "Endotracheal intubation", "correct": false}, {"label": "B", "text": "Needle cricothyroidotomy", "correct": false}, {"label": "C", "text": "Tracheostomy", "correct": true}, {"label": "D", "text": "Oropharyngeal airway", "correct": false}], "correct_answer": "C. Tracheostomy", "question_images": ["https://image.prepladder.com/content/N1173BmkJvvCER9BoLZy1747981579.png"], "explanation_images": ["https://image.prepladder.com/content/qf571g5aeFjq1BkK2z041747122204.png"], "explanation": "<p>Correct Answer C- Tracheostomy</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (tumors, foreign body)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged mechanical ventilation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurological conditions (e.g., <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord injury)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incision made below vocal cords, tube inserted into trachea.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tube Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cuffed:</strong> for <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> support.</p>\n<p><strong>Uncuffed:</strong> for stable <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> or weaning.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infection, bleeding, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> stenosis, <span class=\"customMeta\" data-dictid=\"fb7ff97e071692777180252299cf10\">accidental</span> dislodgement, <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> difficulty.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regular cleaning, monitoring for infection, and tube changes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Comfortable for long-term ventilation, lower risk of <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> damage compared to intubation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female homemaker arrives with symptoms of nasal congestion, reduced sense of smell, and a dry discharge from the nose that is greenish and crusty. Upon examination, the nasal passages appear spacious, and the turbinates are found to be shriveled. Which surgical procedure would be suitable for this patient?", "options": [{"label": "A", "text": "Submucous resection", "correct": false}, {"label": "B", "text": "Young’s operation", "correct": true}, {"label": "C", "text": "Septoplasty", "correct": false}, {"label": "D", "text": "Vidian neurectomy", "correct": false}], "correct_answer": "B. Young’s operation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- Young\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 15 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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Lymphatic spread", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/93OUCUHrLBtdWhwUf9xB1744996422.mp3", "video": ""}, {"text": "A 45-year-old patient presents with a severe headache and fever. The patient has a history of chronic otitis media. The CT scan is shown below. Which of the following statements best describes the most common complication in this patient?", "options": [{"label": "A", "text": "Localized pus collection within the brain parenchyma .", "correct": true}, {"label": "B", "text": "Inflammation of the meninges.", "correct": false}, {"label": "C", "text": "Pus accumulation between the skull and dura mater.", "correct": false}, {"label": "D", "text": "Blood clot formation in the sigmoid sinus.", "correct": false}], "correct_answer": "A. Localized pus collection within the brain parenchyma .", "question_images": ["https://image.prepladder.com/content/1zECCXdbj19t2xzGedv41738669027.png"], "explanation_images": ["https://image.prepladder.com/content/4Hj4oHxXwBL2emf1eRvm1738669076.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6MUAlkf8nN7ZDt90IjKq1745001149.mp3", "video": ""}, {"text": "Which of the following is the most common extracranial complication of Acute Otitis Media?", "options": [{"label": "A", "text": "Labyrinthitis", "correct": false}, {"label": "B", "text": "Facial Nerve Palsy", "correct": false}, {"label": "C", "text": "Mastoiditis", "correct": true}, {"label": "D", "text": "Septicemia", "correct": false}], "correct_answer": "C. Mastoiditis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Bf65cepaQ8x304r7a3OQ1745000601.mp3", "video": ""}, {"text": "Which of the following statements about acute mastoiditis is false?", "options": [{"label": "A", "text": "Persistent fever despite antibiotics.", "correct": false}, {"label": "B", "text": "Mastoid swelling is seen.", "correct": false}, {"label": "C", "text": "Sagging of the posterosuperior meatal wall.", "correct": false}, {"label": "D", "text": "Pinna usually pushed backwards and upwards.", "correct": true}], "correct_answer": "D. Pinna usually pushed backwards and upwards.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BGmxVm9ni50fFczY3cr61738669269.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5cIKS9F1CKJIOE6HRSMm1745000041.mp3", "video": ""}, {"text": "A 5-year-old child with persistent fever, severe ear pain, and swelling behind the ear, despite antibiotic treatment for acute otitis media. Physical examination reveals significant mastoid tenderness. What would you expect to see on the CT scan, and what is the most appropriate treatment?", "options": [{"label": "A", "text": "Normal air cells;Observation and follow-up", "correct": false}, {"label": "B", "text": "Clear air cells; Cortical mastoidectomy", "correct": false}, {"label": "C", "text": "Clear air cells; Antifungal therapy", "correct": false}, {"label": "D", "text": "Cavity formation; Antibiotics", "correct": true}], "correct_answer": "D. Cavity formation; Antibiotics", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3oV42ptRyvHtVrBhjZCc1738669384.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RArvTRimf0YpoRoH0CXh1744999371.mp3", "video": ""}, {"text": "Which of the following is the classic triad of symptoms associated with Gradenigo Syndrome?", "options": [{"label": "A", "text": "Fever, facial swelling, and hearing loss", "correct": false}, {"label": "B", "text": "External rectus palsy, retro-orbital pain, and Ear discharge", "correct": true}, {"label": "C", "text": "Nausea, vertigo, and tinnitus", "correct": false}, {"label": "D", "text": "Headache, neck stiffness, and photophobia", "correct": false}], "correct_answer": "B. External rectus palsy, retro-orbital pain, and Ear discharge", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aYBEDBiSpwwCcbvUY8yK1738669806.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/E5a0lHyHU7TD2ZWBKabU1744998930.mp3", "video": ""}, {"text": "A 58-year-old patient has intermittent vertigo, particularly triggered while cleaning his ear. Otoscopic examination reveals a tympanic membrane perforation. A fistula test is positive, and imaging confirms localized erosion of the horizontal semicircular canal. What is the most common cause of this condition?", "options": [{"label": "A", "text": "CSOM with cholesteatoma", "correct": true}, {"label": "B", "text": "Acute otitis media", "correct": false}, {"label": "C", "text": "Sequelae of serous labyrinthitis", "correct": false}, {"label": "D", "text": "Glomus tumour", "correct": false}], "correct_answer": "A. CSOM with cholesteatoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:723px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Circumscribed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse serous</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse suppurative</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thinning or <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> </strong>of the bony <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> of the labyrinth</li>\n<li>Most commonly <strong>horizontal semicircula</strong>r <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> is involved</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diffuse intralabyrinthine inflammation</strong> without <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> formation</li>\n<li>It is <strong>reversible</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diffuse <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">pyogenic</span> infection</strong> of the labyrinth.</li>\n<li><strong>Permanent loss of <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> and cochlear functions</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most common: Chronic <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media with <span class=\"customMeta\" data-dictid=\"e43816c49b1692777184ac533b9107\">cholesteatoma</span> </strong><strong>(Option A)</strong></li>\n<li>Neoplasms of the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> like <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumour <strong>(Option D ruled out)</strong></li>\n<li>Surgical or <span class=\"customMeta\" data-dictid=\"fb7ff97e071692777180252299cf10\">accidental</span> trauma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Most common:</strong> <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of preexisting <span class=\"customMeta\" data-dictid=\"89aa50eac91692777184c8f668d2cf\">circumscribed</span> <span class=\"customMeta\" data-dictid=\"07b61039101692777191ff0312bb91\">labyrinthitis</span> associated with chronic <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"56a39e9dae169277719923b12d72d1\">suppuration</span> or cholesteatoma.</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media <strong>(Option B ruled out)</strong></li>\n<li>Following a <span class=\"customMeta\" data-dictid=\"2a74a27db91692777199401143be5d\">stapedectomy</span> or <span class=\"customMeta\" data-dictid=\"04cb20b9971692777202ab9568884b\">fenestration</span> operation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progression of <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"07b61039101692777191ff0312bb91\">labyrinthitis</span> associated with <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">pyogenic</span> organisms <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transient <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> and <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> by pressure on the tragus, cleaning the ear, or Valsalva maneuver</li>\n<li><strong>Fistula sign is positive</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertigo (single long episode) with <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> hearing loss.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> with <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and vomiting</li>\n<li>Total <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> hearing loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nystagmus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Positive</strong> pressure- <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> to the <strong>same </strong>side</li>\n<li><strong>Negative </strong>pressure- <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> to the <strong>opposite</strong> side</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nystagmus to the affected side</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nystagmus to the opposite side</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management of the cause</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibacterial therapy</li>\n<li>Labyrinthine sedatives</li>\n<li>Surgery: <strong>Cortical mastoidectomy</strong> or modified radical mastoidectomy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is the same as <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> labyrinthitis</li>\n<li><strong>Drainage of the <span class=\"customMeta\" data-dictid=\"7732c8e49d169277719171da17de32\">labyrinth</span> to evacuate the pus</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WyNKgS8CNpY5YcBwJBRP1744998595.mp3", "video": ""}, {"text": "A 6-year-old child is admitted with high fever, headache, neck stiffness, and altered mental status. The child was recently treated for acute otitis media. Lumbar puncture shows a predominance of polymorphs, protein level is raised, sugars reduced and chlorides diminished. Otoscopic examination reveals bulging of the tympanic membrane. Which of the following is the most appropriate immediate intervention to manage the underlying cause?", "options": [{"label": "A", "text": "Myringotomy", "correct": true}, {"label": "B", "text": "Radical mastoidectomy", "correct": false}, {"label": "C", "text": "Modified radical mastoidectomy", "correct": false}, {"label": "D", "text": "Culture and sensitivity of CSF", "correct": false}], "correct_answer": "A. Myringotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mJzYSii3Ghv97yOTmaLo1744998332.mp3", "video": ""}, {"text": "A 42-year-old right-handed patient with a history of chronic suppurative otitis media presents with headache, fever, and left-sided weakness. On examination, nominal aphasia, homonymous hemianopia, and reduced power in his left limbs are noted. CT scan is shown below. Which of the following is the most likely route of infection spread in this patient?", "options": [{"label": "A", "text": "Retrograde thrombophlebitis", "correct": false}, {"label": "B", "text": "Direct extension from the mastoid cavity", "correct": false}, {"label": "C", "text": "Retrograde spread through the lymphatic system", "correct": false}, {"label": "D", "text": "Both A and B are correct", "correct": true}], "correct_answer": "D. Both A and B are correct", "question_images": ["https://image.prepladder.com/content/mXlSW27pMVOl9p0mk3ee1738669952.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vEyhPzhugM4vd1gm9F2v1744997566.mp3", "video": ""}, {"text": "A 45-year-old male with a history of chronic otitis media, presents with severe headache, fever, and confusion. Fundoscopy reveals papilledema. Collection of pus between the dura mater and the arachnoid mater is visualized on MRI brain. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Extradural abscess", "correct": false}, {"label": "B", "text": "Subdural abscess", "correct": true}, {"label": "C", "text": "Cerebral abscess", "correct": false}, {"label": "D", "text": "Epidural abscess", "correct": false}], "correct_answer": "B. Subdural abscess", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:684px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extradural abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subdural abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> between the bone and dura.<strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> and arachnoid. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most of the time it is asymptomatic, <strong>SILENT abscess</strong>.</li>\n<li><strong>Persistent headache</strong> on the side of <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media</li>\n<li>Severe ear pain</li>\n<li><strong>Pulsatile</strong> <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> ear <strong>discharge</strong></li>\n<li>Disappearance of headache with free flow of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> from the ear (spontaneous <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> drainage)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Meningeal irritation</li>\n<li>Cortical <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Thrombophlebitis</li>\n<li><strong>Raised <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">Intracranial</span> Tension</strong></li>\n<li>Focal neurological deficits</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CT/MRI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CT/MRI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mastoidectomy</strong> for <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> of the disease</li>\n<li>IV antibiotics</li>\n<li>Drainage of pus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Burr holes or a <span class=\"customMeta\" data-dictid=\"cecf1b86e61692777185f281991f2d\">craniotomy</span> to drain <span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\">subdural</span> empyema</li>\n<li>IV antibiotics</li>\n<li>Later, <span class=\"customMeta\" data-dictid=\"12d9c7a4041692777191aa892d206f\">mastoidectomy</span> for <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> of disease</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/npKYIEHqudc7uA6YZN9L1744997310.mp3", "video": ""}, {"text": "A 30-year-old male with a history of chronic suppurative otitis media complaints of fever with chills and rigors, ear pain, and headache. On examination, he has mastoid tenderness. Fundoscopy reveals papilledema and engorgement of retinal veins when the jugular vein is compressed. A CT scan is done and shown below. Which of the following radiological findings is most consistent with lateral/sigmoid sinus thrombophlebitis?", "options": [{"label": "A", "text": "Griesinger Sign", "correct": false}, {"label": "B", "text": "Delta sign", "correct": true}, {"label": "C", "text": "Ring enhancement", "correct": false}, {"label": "D", "text": "Crescent sign", "correct": false}], "correct_answer": "B. Delta sign", "question_images": ["https://image.prepladder.com/content/REPwbKOP4QA3jdrBfb2B1738670179.png"], "explanation_images": ["https://image.prepladder.com/content/bRUl72sNGTuYzTAlIuRS1738670355.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CrQSXrviyFPJVwglUxNJ1744997027.mp3", "video": ""}, {"text": "A patient with otitic hydrocephalus develops headaches, visual disturbances, and papilledema but no focal neurological deficits. Which of the following findings would most likely be seen on lumbar puncture?", "options": [{"label": "A", "text": "Normal CSF composition with elevated opening pressure", "correct": true}, {"label": "B", "text": "High neutrophil count in the CSF", "correct": false}, {"label": "C", "text": "Decreased glucose and elevated protein in the CSF", "correct": false}, {"label": "D", "text": "Low opening pressure and elevated protein", "correct": false}], "correct_answer": "A. Normal CSF composition with elevated opening pressure", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KM1PKJwZVA2541RIPS5I1744996763.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 22 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 23 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Patient diagnosed with chronic suppurative otitis media has been planned for Tympanoplasty. All among the following are landmarks to identify the commonly injured nerve during this procedure except", "options": [{"label": "A", "text": "Oval window", "correct": false}, {"label": "B", "text": "Posterior belly of digastric", "correct": true}, {"label": "C", "text": "Processus cochleariformis", "correct": false}, {"label": "D", "text": "Incus short process", "correct": false}], "correct_answer": "B. Posterior belly of digastric", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NjPeN8Vtuu6aBA5AUHtP1738692924.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MIDDLE EAR AND MASTOID:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1) <span class=\"customMeta\" data-dictid=\"e6bd999a0f1692777196f29e69ec67\">Processus</span> Cochleariformis </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>tympanic segment of nerve starts at this level</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2) <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">Oval</span> Window &amp; <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">Horizontal</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>runs superior to the <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> window (stapes) and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> to the <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> canal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3) Short Process of <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">Incus</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>medial to the short process of <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> at the aditus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4) Pyramid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>passes behind the <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> sulcus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5) <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> ridge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>nerve exits the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> at the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> end of the <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> ridge.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PAROTID:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1) <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">Cartilaginous</span> Pointer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>located 1 cm deep, slightly <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> to this triangular cartilage</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2) Tympanomastoid Suture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>lies 6-8 mm deep to the suture</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3) <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">Styloid</span> Process</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>crosses <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to the <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4) <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> Belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>between the <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> belly of the <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> muscle</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Uf1pwDsn2cUv7JlyUWgX1741325041.mp3", "video": ""}, {"text": "Which of the following statements regarding the development of ear ossicles and inner ear is false?", "options": [{"label": "A", "text": "Malleus and incus are developed from first pharyngeal arch", "correct": false}, {"label": "B", "text": "Stapes footplate is developed from otic capsule", "correct": false}, {"label": "C", "text": "Cochela develops from otocyst", "correct": false}, {"label": "D", "text": "A part of the stapes develops from the third pharyngeal arch", "correct": true}], "correct_answer": "D. A part of the stapes develops from the third pharyngeal arch", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wrZnOUh0kp61tnvUkCXs1738699873.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:496px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ossicle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Embryonic Source</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malleus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesoderm of the first pharyngeal arch</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesoderm of the first pharyngeal arch</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stapes</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Footplate and <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of stapes-Otic capsule</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Rest-Second pharyngeal arch</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FaQVcZVKEp40IrxGZI6m1741339242.mp3", "video": ""}, {"text": "Match the layers of tympanic membrane to the germinal layer from which it developes. Layers of tympanum Germinal layer a.Epithelial layer 1.Ectoderm b.Fibrous layer 2.Endoderm c.Mucosal layer 3.Mesoderm", "options": [{"label": "A", "text": "a1,b3,c2", "correct": true}, {"label": "B", "text": "a1,b2,c3", "correct": false}, {"label": "C", "text": "a3,b2,c1", "correct": false}, {"label": "D", "text": "a2,b1,c3", "correct": false}], "correct_answer": "A. a1,b3,c2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/C1rfXadHwQSt9yh4hL5S1738699776.png", "https://image.prepladder.com/content/JIGrXSxB2411KPU3DlRo1738699807.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cVubzl95jphqT3YAyM9B1741340239.mp3", "video": ""}, {"text": "Which of the following structures pass through the internal auditory canal?", "options": [{"label": "A", "text": "Facial nerve, cochlear nerve, and trigeminal nerve", "correct": false}, {"label": "B", "text": "Cochlear nerve, vestibular nerve, and facial nerve", "correct": true}, {"label": "C", "text": "Optic nerve, oculomotor nerve, and facial nerve", "correct": false}, {"label": "D", "text": "Glossopharyngeal nerve, vagus nerve, and accessory nerve", "correct": false}], "correct_answer": "B. Cochlear nerve, vestibular nerve, and facial nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u0ZMrk4ZdlMGjP4S3vLU1738699538.png", "https://image.prepladder.com/content/VmZy1wwfsCEDf9KzXPhC1738699568.png", "https://image.prepladder.com/content/6pWEbKXLuPh1uaSCmQG21738699599.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/X3SGkAssJBHeTHm7Tc6P1741340484.mp3", "video": ""}, {"text": "A 35-year-old male presents with progressive right-sided hearing loss, intermittent tinnitus, and a sensation of fullness. An audiogram shows significant sensorineural hearing loss. Which structure is most likely affected?", "options": [{"label": "A", "text": "Malleus", "correct": false}, {"label": "B", "text": "Eustachian tube", "correct": false}, {"label": "C", "text": "Organ of Corti", "correct": true}, {"label": "D", "text": "Semicircular canals", "correct": false}], "correct_answer": "C. Organ of Corti", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bEDq6q8RMEXr147jwtF71739256149.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:511px\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Inner hair cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Outer hair cells</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Total count and Rows</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3500 and 1 row</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12,000 and 3-4 rows</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flask shaped</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cylindrical shape</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nerve supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mainly afferent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mainfly efferent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transmit <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> stimuli</li>\n<li>More resistant</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Modulate function of inner hair cells.</li>\n<li>Easily damaged by <span class=\"customMeta\" data-dictid=\"2120ab70f61692777194f45de53df3\">ototoxic</span> drugs and high-intensity noise</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ug6FY11tPV2IBrlkSvZO1746641243.mp3", "video": ""}, {"text": "Which of the following statements correctly identifies the primary ionic components of endolymph and perilymph in the cochlea?", "options": [{"label": "A", "text": "Endolymph is high in sodium (Na+), and perilymph is high in potassium (K+).", "correct": false}, {"label": "B", "text": "Endolymph is high in potassium (K+), and perilymph is high in sodium (Na+).", "correct": true}, {"label": "C", "text": "Both endolymph and perilymph are high in sodium (Na+).", "correct": false}, {"label": "D", "text": "Both endolymph and perilymph are high in potassium (K+).", "correct": false}], "correct_answer": "B. Endolymph is high in potassium (K+), and perilymph is high in sodium (Na+).", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/op3l7DYAkbmmdf7kCuvR1738699367.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:287px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sodium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potassium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endolymph</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>144</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perilymph</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>140</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bsOwRlojKIFcuMGJDl1e1741341400.mp3", "video": ""}, {"text": "In the cochlea, high-frequency sounds are primarily detected at which location along the basilar membrane?", "options": [{"label": "A", "text": "Apex of the cochlea", "correct": false}, {"label": "B", "text": "Base of the cochlea", "correct": true}, {"label": "C", "text": "Middle of the cochlea", "correct": false}, {"label": "D", "text": "Near the helicotrema", "correct": false}], "correct_answer": "B. Base of the cochlea", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r2aWWt6btZ4dKZflj8B91738699228.png", "https://image.prepladder.com/content/XPPaJfCaccAoAZ5F5ARO1738699288.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yugJXPRWtY5OgMtFJWWj1741341557.mp3", "video": ""}, {"text": "Which of the following accurately describes the anatomy and function of the semicircular canals? The lateral, posterior, and superior canals are oriented perpendicular to each other. Each semicircular canal has an ampullated end that contains the crista ampullaris, which detects angular acceleration. The membranous ducts within the bony canals are filled with perilymph and surrounded by endolymph. The crus commune is formed by the non-ampullated ends of the posterior and superior canals and opens into the vestibule. The semicircular canals are located within the bony labyrinth in the frontal bone.", "options": [{"label": "A", "text": "1,2,4", "correct": true}, {"label": "B", "text": "1", "correct": false}, {"label": "C", "text": "1,4", "correct": false}, {"label": "D", "text": "1,2", "correct": false}], "correct_answer": "A. 1,2,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BdCTcKGk80abQ10vFJUS1738699135.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Semicircular canals </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within the <span class=\"customMeta\" data-dictid=\"8f50a352d71692777183234f97f2dd\">bony labyrinth</span> in the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone.(statement 5 ruled out )</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The semicircular canals aid in balance and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> orientation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Canals and Planes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>3 Canals: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Canal; <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> Canal; Superior Canal</strong></li>\n<li><strong>Each <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> is perpendicular to each other. </strong><strong>(statement 1)</strong></li>\n<li>Three canals open into the <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> through five openings.</li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/BdCTcKGk80abQ10vFJUS1738699135.png\" width=\"500\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluids </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Membranous semicircular ducts are inside the bony semicircular canals</li>\n<li>Membranous semicircular ducts are filled with <span class=\"customMeta\" data-dictid=\"5f331cddb3169277718749f0c2a1d9\">endolymph</span> and surrounded by <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> (statement 3 ruled out )</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ampullae and <span class=\"customMeta\" data-dictid=\"653381031a1692777185f2d7287a66\">Crus</span> Commune</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Each <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> has an ampullated end, a wider portion containing a <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> structure called the <span class=\"customMeta\" data-dictid=\"855c7f67b916927771851af573bb2a\">crista</span> ampullaris. </strong><strong>(statement 2)</strong>\n<ul>\n<li><strong>Detect <span class=\"customMeta\" data-dictid=\"777420204116927771812106969c5e\">angular</span> <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> (head rotation):</strong> <span class=\"customMeta\" data-dictid=\"248a37a887169277718529fd90fbed\">Cristae</span> ampullaris contain hair cells that sense <span class=\"customMeta\" data-dictid=\"5f331cddb3169277718749f0c2a1d9\">endolymph</span> movement and send balance signals to the brain.</li>\n</ul>\n</li>\n<li><strong>The non-ampullated ends of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> and superior canals merge to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a common channel called the <span class=\"customMeta\" data-dictid=\"653381031a1692777185f2d7287a66\">crus</span> commune before entering the vestibule. </strong><strong>(statement 4)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vK8b0t3tzBClKvX2IV0D1741341852.mp3", "video": ""}, {"text": "Which structure in the vestibule of the inner ear contains the structure involved in detecting linear acceleration and deceleration.?", "options": [{"label": "A", "text": "Organ of Corti", "correct": false}, {"label": "B", "text": "Vestibular aqueduct", "correct": false}, {"label": "C", "text": "Semicircular canals", "correct": false}, {"label": "D", "text": "Spherical recess", "correct": true}], "correct_answer": "D. Spherical recess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/o3VJiwBc7yMT7lanTXOM1738699004.png", "https://image.prepladder.com/content/E3drB6nOsQmZVbKlUzkw1738699054.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parts of the Inner Ear</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The inner ear, or labyrinth, is essential for hearing and balance and is located within the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone. It consists of the <span class=\"customMeta\" data-dictid=\"8f50a352d71692777183234f97f2dd\">bony labyrinth</span> and the membranous labyrinth.</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/o3VJiwBc7yMT7lanTXOM1738699004.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bony Labyrinth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rigid structure filled with <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> (a sodium-rich fluid), it has three main parts:</p>\n<ol>\n<li><strong>Vestibule</strong><strong>:</strong> Central part connecting to the <span class=\"customMeta\" data-dictid=\"6eb2dc23ea16927771848e85bcecb2\">cochlea</span> and semicircular canals.\n\n\t\t\t\t<ul>\n<li>Bony Recesses in the <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> contains the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> and <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> (part of the membranous labyrinth).\n\t\t\t\t\t<ul>\n<li><strong>Spherical Recess: </strong>Contains the saccule, a membranous <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> involved in detecting <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and deceleration.</li>\n<li>Elliptical Recess: Contains the utricle, which works with the <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> to aid in balance and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> orientation. <strong> </strong></li>\n</ul>\n</li>\n<li>Oval Window: Located on the vestibule’s <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall, it connects to the middle ear.</li>\n<li>Openings of the Semicircular Canals: The three semicircular canals (lateral, posterior, and superior) have five openings into the vestibule, enabling <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of head rotations.</li>\n<li>Opening of the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> Aqueduct: Positioned below the elliptical recess, it allows the passage of the endolymphatic duct, which carries <span class=\"customMeta\" data-dictid=\"5f331cddb3169277718749f0c2a1d9\">endolymph</span> within the membranous labyrinth.</li>\n</ul>\n</li>\n<li><strong>Semicircular Canals:</strong> Three canals (lateral, posterior, and superior) positioned at right angles to detect rotational head movement. Each has an <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> containing the <span class=\"customMeta\" data-dictid=\"855c7f67b916927771851af573bb2a\">crista</span> ampullaris for <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> function.</li>\n<li><strong>Cochlea:</strong> A <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> structure essential for hearing, divided into three chambers (scala vestibuli, <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> tympani, and <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> media). The <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> vestibuli and tympani contain <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> and communicate via the helicotrema, while the <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> media houses the organ of Corti, which converts sound vibrations into electrical signals.</li>\n</ol>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/E3drB6nOsQmZVbKlUzkw1738699054.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Membranous Labyrinth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A delicate system within the bony labyrinth, filled with potassium-rich endolymph, it includes:</p>\n<ol>\n<li><strong>Cochlear <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> (Scala Media):</strong> Inside the cochlea, it separates the <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> vestibuli and <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> tympani and contains the <span class=\"customMeta\" data-dictid=\"29bb9bd7941692777194f232aa822a\">organ of Corti</span> for hearing.</li>\n<li><strong>Utricle and Saccule:</strong> Membranous sacs in the <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> responsible for detecting <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and balance. They are connected via the <span class=\"customMeta\" data-dictid=\"637ee8854016927772017070137245\">utriculosaccular</span> duct.</li>\n<li><strong>Semicircular Ducts:</strong> Membranous ducts within the bony semicircular canals, contributing to balance.</li>\n<li><strong>Endolymphatic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> and Sac:</strong> Extending from the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> and saccule, the <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> ends in the endolymphatic sac, important in <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> treatments for conditions like Ménière's disease.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tumBW2P3cZDBOLBCaIno1741342071.mp3", "video": ""}, {"text": "A 45-year-old patient is undergoing a mastoidectomy for chronic mastoiditis. During surgery, the surgeon encounters a structure that obstructs access to the deeper petrosal air cells. What is the most likely anatomical structure causing this surgical challenge?", "options": [{"label": "A", "text": "Sigmoid sinus", "correct": false}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Korner's septum", "correct": true}, {"label": "D", "text": "Tegmen tympani", "correct": false}], "correct_answer": "C. Korner's septum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Pw38COZBdu8WIeb5kQUo1738698921.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Korner's septum</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Korner's <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> is a bony plate in the mastoid, separating the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> <span class=\"customMeta\" data-dictid=\"737d377e061692777199508424034e\">squamosal</span> air cells from the deeper <span class=\"customMeta\" data-dictid=\"e3c6e8362e1692777195a07373caf0\">petrosal</span> air cells.</li>\n<li>It is a <span class=\"customMeta\" data-dictid=\"bead1cecfa16927771979940742ada\">remnant</span> of the developmental <span class=\"customMeta\" data-dictid=\"ca48c27f751692777195bf6f82644a\">petrosquamous</span> suture.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/Pw38COZBdu8WIeb5kQUo1738698921.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>During Mastoidectomy: Korner's <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> is important when removing infected <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> air cells.</li>\n<li>Challenges in Locating the Antrum: A prominent Korner's <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> can block access to the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> antrum, complicating surgery.</li>\n<li>Incomplete Disease Removal: If Korner's <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> is not fully removed, deeper infected air cells may be missed, leading to persistent or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infection.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qlapybHh0qChK56Dor151741327376.mp3", "video": ""}, {"text": "Which of the following describes the posterior boundary of MacEwen's triangle?", "options": [{"label": "A", "text": "Temporal line (supramastoid crest)", "correct": false}, {"label": "B", "text": "Posterosuperior part of the bony external auditory canal", "correct": false}, {"label": "C", "text": "A tangent line drawn from the external auditory canal", "correct": true}, {"label": "D", "text": "Tegmen tympani", "correct": false}], "correct_answer": "C. A tangent line drawn from the external auditory canal", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JlmsFg4oIfSOG1RRd1Nn1738698843.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MacEwen's <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> (Suprameatal Triangle)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MacEwen's <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> is a key <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> landmark for identifying the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> during <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> surgery.</li>\n<li>It is located on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> process, the bony <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> behind the ear.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> represents the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall of the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> antrum.</li>\n<li>Clinical importance of Macewen triangle: the <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> lies approximately 1.5 cm deep to the triangle. It is an important landmark to locate the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> in <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> surgery.</li>\n<li>At birth, the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> antral wall is about 2 mm thick and thickens by 1 mm per year, reaching 12-15 mm in adulthood.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"005bedacc61692777199e86257039b\">supramastoid</span> <span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\">crest</span> corresponds to the floor of the middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Boundaries of MacEwen's Triangle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Superiorly</strong>: <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> line (supramastoid crest)</li>\n<li><strong>Anteriorly</strong>: <span class=\"customMeta\" data-dictid=\"18ea7646491692777196c2509104c9\">Posterosuperior</span> part of the bony external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal</li>\n<li><strong>Posteriorly</strong>: A tangent line drawn from the external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal<strong> (Option C)</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/JlmsFg4oIfSOG1RRd1Nn1738698843.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QtUqbfM35HHAHELIyOJm1741325278.mp3", "video": ""}, {"text": "Label the contents of middle ear appropriately", "options": [{"label": "A", "text": "a-Incus, b-Stapedius, c-Stapes , d-Tensor tympani, e-Malleus", "correct": true}, {"label": "B", "text": "a-Incus, b-Stapes, c-Stapedius , d-Tensor tympani, e-Malleus", "correct": false}, {"label": "C", "text": "a-Incus, b-Tensor tympani, c-Stapes , d-Stapedius, e-Malleus", "correct": false}, {"label": "D", "text": "a-Malleus, b-Stapedius, c-Stapes , d-Tensor tympani, e- Incus", "correct": false}], "correct_answer": "A. a-Incus, b-Stapedius, c-Stapes , d-Tensor tympani, e-Malleus", "question_images": ["https://image.prepladder.com/content/FPsYNtreRr7khgcSGAhn1738698655.png"], "explanation_images": ["https://image.prepladder.com/content/WSnYdlIXKWvzQ1cA0B1P1738698687.png", "https://image.prepladder.com/content/3DGPQ4bK5fwgXSM1QIEF1738698733.png", "https://image.prepladder.com/content/EKrbeyE2ehbO6lISHJHY1738698764.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle Ear</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> is an air-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> extending from the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, including the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube, aditus, antrum, and <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> air cells (collectively called the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> cleft).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Walls of the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">Middle Ear</span> (Six-Sided Box)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Roof (Tegmen Tympani):</strong> Thin bone separating the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> from the middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa, extending to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the roof of the <span class=\"customMeta\" data-dictid=\"d1ca21a2cc169277718061181b0369\">aditus</span> and antrum.</li>\n<li><strong>Floor</strong>: Thin bone separating the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> from the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb, sometimes deficient leading to <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb projection.</li>\n<li><strong>Anterior Wall</strong>: Thin bone between the <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery; contains openings for the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube and <span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\">tensor</span> tympani muscle.</li>\n<li><strong>Posterior Wall:</strong><strong> </strong>Features the <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> (stapedius tendon), <span class=\"customMeta\" data-dictid=\"d1ca21a2cc169277718061181b0369\">aditus</span> (connecting <span class=\"customMeta\" data-dictid=\"d451dc2fa616927771825c26632142\">attic</span> and antrum), and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve.</li>\n<li><strong>Medial Wall:</strong> Formed by the labyrinth, includes the <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> (cochlea bulge), <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> and round windows, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve canal, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> prominence, and <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> tympani.</li>\n<li><strong>Lateral Wall:</strong> Primarily the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, with the <span class=\"customMeta\" data-dictid=\"79d2ff4447169277719882d2efb3d5\">scutum</span> (bony outer <span class=\"customMeta\" data-dictid=\"d451dc2fa616927771825c26632142\">attic</span> wall) contributing.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contents of the Middle Ear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Ossicles: </strong>Malleus, incus, and <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> transmit sound from the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> to the inner ear.</li>\n<li><strong>Intratympanic Muscles:</strong><strong> </strong>Tensor tympani (attaches to malleus) and <span class=\"customMeta\" data-dictid=\"392f0cadaf1692777199b8172a5962\">stapedius</span> (attaches to stapes, dampens loud sounds).</li>\n<li><strong>Chorda Tympani Nerve</strong><strong>: </strong>A branch of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve, carries taste from the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> two-thirds of the tongue and controls salivary glands.</li>\n<li><strong>Tympanic Plexus:</strong>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> is located on the <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> and is formed by\n\t\t\t\t\t<ul>\n<li>Tympanic branch of the <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> nerve</li>\n<li>Sympathetic fibres from the <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> around the internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n</ul>\n</li>\n<li>It innervates the middle ear, <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> air cells, and <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube.</li>\n</ul>\n</li>\n<li><strong>Air</strong>: The <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> is air-filled, lined by <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membrane.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ArCplMgk3xJy05NsVPnC1746544274.mp3", "video": ""}, {"text": "Which structure, located in the petrous part of the temporal bone, is responsible for transmitting the facial nerve (VII) and is commonly involved in pathological conditions such as acoustic neuroma affecting the cerebellopontine angle?", "options": [{"label": "A", "text": "Tegmen tympani", "correct": false}, {"label": "B", "text": "Stylomastoid foramen", "correct": false}, {"label": "C", "text": "Internal auditory canal", "correct": true}, {"label": "D", "text": "Jugular foramen", "correct": false}], "correct_answer": "C. Internal auditory canal", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QlIUziQ3ubVbGiBDBfiY1739255997.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomy of the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Bone</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Segments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Tympanic</strong>: Forms the external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> (EAC).</p>\n<p><strong>2. Mastoid: </strong></p>\n<ul>\n<li>Contains the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> air cell system, which is essential for <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of the middle ear.</li>\n<li>Includes the antrum, connected to the epitympanum, and surrounded by air cells.</li>\n</ul>\n<p><strong>3. Petrous</strong>:</p>\n<ul>\n<li>Most <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> part, containing the cochlea, vestibule, semicircular canals and internal <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal.</li>\n<li>Houses the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve (VII) and <span class=\"customMeta\" data-dictid=\"b774537d0c1692777201dee32072fe\">vestibulocochlear</span> nerve (VIII).</li>\n</ul>\n<p><strong>4.</strong> <strong>Squamous</strong>: Flat part of the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone that contributes to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> skull wall, providing <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> points for muscles and ligaments.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"209\" src=\"https://image.prepladder.com/content/QlIUziQ3ubVbGiBDBfiY1739255997.png\" width=\"400\"/></p>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Important associated Structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cranial Nerves:</strong>\n<ul>\n<li>Facial nerve (VII) and <span class=\"customMeta\" data-dictid=\"b774537d0c1692777201dee32072fe\">Vestibulocochlear</span> nerve (VIII) passes through the internal <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal</li>\n<li>9th, 10th, and 11th <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves (glossopharyngeal, vagus, accessory) run through the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen.</li>\n</ul>\n</li>\n<li><strong>Vascular Structures</strong>:\n\t\t\t\t<ul>\n<li>Jugular bulb and <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> run near the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> portion, making the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone a critical area for <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> considerations.</li>\n<li>Labyrinthine <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> passes through the internal <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal</li>\n<li>Internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">Jugular</span> Veins make their way out of the <span class=\"customMeta\" data-dictid=\"7445cc70001692777185aa80cea71c\">cranium</span> and terminate at the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> veins via <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen.</li>\n</ul>\n</li>\n<li><strong>Other structures:</strong> Internal <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal, cochlea, vestibule, semicircular canals, <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> aqueduct, endolymphatic sac<strong>.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7gAIw92WL4ipJdlE8dFE1741159477.mp3", "video": ""}, {"text": "Patient underwent surgery for cholesteatoma 1 year back, now has presented with similar complaints again. Which among the following is the most common site of residual cholesteatoma?", "options": [{"label": "A", "text": "Facial nerve canal", "correct": false}, {"label": "B", "text": "Ponticulus", "correct": false}, {"label": "C", "text": "Sinus tympani", "correct": true}, {"label": "D", "text": "Facial recess", "correct": false}], "correct_answer": "C. Sinus tympani", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/b7GT8IY5vaXiNTzw5vWU1738682887.png", "https://image.prepladder.com/content/KuIxJsXHJL0kF1PVjk3C1738682949.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Promontory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bulge caused by the <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> <span class=\"customMeta\" data-dictid=\"d01779560916927771845f3a964516\">coil</span> of the cochlea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oval Window</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Footplate of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> is attached</li>\n<li>Located below the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve canal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Round Window (Fenestra Cochleae)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Covered by the secondary <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Canal for <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Located above the <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> window</li>\n<li>Nerve may be exposed due to dehiscence</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prominence of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Semicircular Canal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Located above the <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> for the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Processus Cochleariformis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hook-like projection <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> window</li>\n<li>Landmark for <span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\">tensor</span> tympani <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> attachment</li>\n<li>First <span class=\"customMeta\" data-dictid=\"7e0d837a391692777188b2820de5f4\">genu</span> of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinus Tympani </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Deep <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the pyramid</li>\n<li><strong>Bounded by the <span class=\"customMeta\" data-dictid=\"60d03afa5f1692777199d5cf2a803f\">subiculum</span> (below) and <span class=\"customMeta\" data-dictid=\"91938c28901692777196a770054296\">ponticulus</span> (above)</strong></li>\n<li>Most common site for residual/recurrent cholesteatoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Facial recess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bounded by vertical segment of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve, <span class=\"customMeta\" data-dictid=\"2085e5a8be169277718425bdd931cb\">chorda</span> tympani and <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> incudis.</li>\n<li>Surgical landmark for <strong>posterior tympanotomy.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GYLqiDJReyViCj27ZNMH1741324720.mp3", "video": ""}, {"text": "A 6-year old child was brought to clinic with recurrent episodes of upper respiratory tract infection. Child also complains of earache during this episodes. Doctor suspects that a structure exiting from anterior wall in middle ear is responsible for his earache. Arrange the following structures in order related to the wall (superior-to-inferior) 1) Internal carotid artery 2) Pharyngo-tympanic tube 3) Tensor tympani", "options": [{"label": "A", "text": "3-1-2", "correct": false}, {"label": "B", "text": "2-3-1", "correct": false}, {"label": "C", "text": "3-2-1", "correct": true}, {"label": "D", "text": "2-1-3", "correct": false}], "correct_answer": "C. 3-2-1", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/L8fD7liYYN06y6sMfS2H1738682792.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1) Supratubal recess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Superior most, present in <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> epitympanum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2) <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> of <span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\">Tensor</span> tympani </strong><strong>(Statement-3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tensor tympani subsequently runs along the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3) Pharyngo-tympanic tube </strong><strong>(Statement-2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Present in middle 3rd, 5x4mm <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> opening</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4) Internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> </strong><strong>(Statement-1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Present in lower 3rd, bony plate covers the artery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/biLFuBhCzlRtyZDscuUG1741167243.mp3", "video": ""}, {"text": "Which among the following are components of the middle ear cleft? 1) Tympanic plexus 2) Stapedius muscle 3) Mastoid air cells 4) Eustachian tube", "options": [{"label": "A", "text": "1,2,3,4", "correct": true}, {"label": "B", "text": "1,2,3", "correct": false}, {"label": "C", "text": "1,2,4", "correct": false}, {"label": "D", "text": "1,2", "correct": false}], "correct_answer": "A. 1,2,3,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dNooUNbsMN7yNC4UgIdQ1738682685.png", "https://image.prepladder.com/content/mjiUWjdsmLifDomFeutM1738682721.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tJbgFsUS6k8yIMVo72wI1741166665.mp3", "video": ""}, {"text": "A 50-year-old woman presents with a traumatic perforation of the tympanic membrane. The image is given below. What type of perforation is this?", "options": [{"label": "A", "text": "Central", "correct": false}, {"label": "B", "text": "Subtotal", "correct": false}, {"label": "C", "text": "Posterosuperior", "correct": false}, {"label": "D", "text": "Attic", "correct": true}], "correct_answer": "D. Attic", "question_images": ["https://image.prepladder.com/content/6gSUyv3wqfAH8EledA4W1738682537.png"], "explanation_images": ["https://image.prepladder.com/content/RImLLWnN8XSQ1Vl4Tfjt1738682574.png", "https://image.prepladder.com/content/rijV4F4vOICXLkSvcpla1738682601.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FKJsPLcgqy3lKXR8AwcU1741013636.mp3", "video": ""}, {"text": "Which of the following statements is false?", "options": [{"label": "A", "text": "Pars tensa forms the majority of the tympanic membrane", "correct": false}, {"label": "B", "text": "Umbo is central part of pars tensa", "correct": false}, {"label": "C", "text": "Sharpnells membrane is pars flaccida", "correct": false}, {"label": "D", "text": "None of the above", "correct": true}], "correct_answer": "D. None of the above", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KfexrsZTp8x5qkDwYfoA1738682471.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pars Tensa</strong></p>\n<br/>\n<br/>\n\t\t\t </td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Forms most of the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane. (Option A)</strong></li>\n<li>Annulus Tympanicus - Thickened fibrocartilaginous ring at the <span class=\"customMeta\" data-dictid=\"316866040e1692777195f45393e010\">periphery</span> that fits into the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> sulcus.</li>\n<li><strong>Umbo - Central part of <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa (Option B)</strong>, tented inward at the tip of the malleus.</li>\n<li>Cone of Light - Bright reflection radiating from the tip of the <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> to the <span class=\"customMeta\" data-dictid=\"316866040e1692777195f45393e010\">periphery</span> in the <span class=\"customMeta\" data-dictid=\"237c382dfb1692777181c96284af69\">anteroinferior</span> quadrant.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pars Flaccida (Shrapnell’s Membrane)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Located above the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> process of the malleus, between the <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">notch</span> of Rivinus and the <span class=\"customMeta\" data-dictid=\"b40e87c6d21692777191f58af0a636\">malleal</span> folds.</li>\n<li>Less taut and may appear slightly pinkish.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Outer Epithelial Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous with the skin lining the external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> meatus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inner Mucosal Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous with the <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of the middle ear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle Fibrous Layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Contains radial, circular, and parabolic fibers and encloses the handle of the malleus.</li>\n<li>In <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">Pars</span> Flaccida - Thin and not organized into distinct fibers as seen in <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XRmVwSYrd4hDZA7SEn3E1741013473.mp3", "video": ""}, {"text": "Which of the following statements on tympanic membrane is false?", "options": [{"label": "A", "text": "Partition between the external acoustic canal and the middle ear.", "correct": false}, {"label": "B", "text": "The posterosuperior part is more medial than the anteroinferior part.", "correct": true}, {"label": "C", "text": "Height 9-10 mm", "correct": false}, {"label": "D", "text": "0.1mm thick", "correct": false}], "correct_answer": "B. The posterosuperior part is more medial than the anteroinferior part.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/80xB6Vgkt70L9C76hKjW1741166040.mp3", "video": ""}, {"text": "Match the parts of the external ear with the corresponding nerve supply Part Nerve supply a.Lower half of medial and lateral surface of pinna 1.Auricular branch of vagus nerve b.Retroauricular groove of the pinna 2.Facial nerve c.Floor of external auditory canal 3.Greater auricular nerve", "options": [{"label": "A", "text": "a3,b2,c1", "correct": true}, {"label": "B", "text": "a1,b2,c3", "correct": false}, {"label": "C", "text": "a3,b1,c2", "correct": false}, {"label": "D", "text": "a2,b3,c1", "correct": false}], "correct_answer": "A. a3,b2,c1", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FXfwwD0Xo7IMj3v2Mg231738682411.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most of the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> surface of pinna- lower half and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part of the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Greater <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve (C2,3)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper part of the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesser <span class=\"customMeta\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\">occipital</span> nerve (C2)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tragus, <span class=\"customMeta\" data-dictid=\"653381031a1692777185f2d7287a66\">crus</span> of helix, and adjacent part of the helix</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Auriculotemporal nerve (V3)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Concha and corresponding <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> on the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Auricular branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> (CN X, Arnold’s nerve)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Concha and <span class=\"customMeta\" data-dictid=\"25d15957af1692777197fb801dd929\">retroauricular</span> groove</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facial nerve (CN VII) distributed with fibers of <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> branch of vagus</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior wall and roof</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Auriculotemporal nerve (V3)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior wall and floor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Auricular branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> (CN X)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior wall (additional supply)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensory fibers of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve (CN VII) through <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> branch of vagus</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Part </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior half of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>auriculotemporal (V3)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior half of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>auricular branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> (CN X).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>tympanic branch of CN IX (Jacobson’s nerve)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6l483neGXJgfutWa6Wsj1741012784.mp3", "video": ""}, {"text": "A 3 year old child presents with swelling and pain in the region of the parotid gland, accompanied by ear discharge. Examination of the external auditory canal (EAC) reveals signs of infection. Which bony anatomical structure is responsible for the spread of infection between the EAC and the parotid gland?", "options": [{"label": "A", "text": "Mastoid air cells", "correct": false}, {"label": "B", "text": "Foramen of Huschke", "correct": true}, {"label": "C", "text": "Isthmus", "correct": false}, {"label": "D", "text": "Tympanic membrane", "correct": false}], "correct_answer": "B. Foramen of Huschke", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jmCcdTa7HMtqhbLYDHCz1738682304.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fSQTu2O9yTEdpVW7iGeN1741165698.mp3", "video": ""}, {"text": "A 10 year old boy presents with ear pain, swelling and redness around the ear. On examination, the external auditory canal is inflamed and furuncles are visible. What part of the external auditory canal is most likely affected?", "options": [{"label": "A", "text": "Bony part of the external auditory canal", "correct": false}, {"label": "B", "text": "Tympanic membrane", "correct": false}, {"label": "C", "text": "Cartilaginous part of the external auditory canal", "correct": true}, {"label": "D", "text": "Mastoid air cells", "correct": false}], "correct_answer": "C. Cartilaginous part of the external auditory canal", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0e7wvpwrUPLA2QocfSGm1738682183.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>External <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Connects <span class=\"customMeta\" data-dictid=\"4896e8326b169277719479df7d8eb2\">outer ear</span> to middle ear, from the <span class=\"customMeta\" data-dictid=\"d132cd1b021692777184bb399da7e4\">concha</span> to the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (eardrum).</li>\n<li>Length &amp; Shape:\n\t\t\t\t<ul>\n<li>Approximately 24 mm long (posterior wall).</li>\n<li>Outer part angles upwards, backwards, and medially.</li>\n<li>Inner part angles downwards, forwards, and medially.</li>\n</ul>\n</li>\n<li>Pinna must be pulled upwards, backwards, and laterally to view the eardrum.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/0e7wvpwrUPLA2QocfSGm1738682183.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cartilaginous Part </strong>(Outer third, approximately 8 mm):\n\t\t\t\t<ul>\n<li>Continuous with <span class=\"customMeta\" data-dictid=\"7aafd1d2571692777195e9d2250eab\">pinna</span> cartilage.</li>\n<li>Fissures of Santorini allow infection to spread.</li>\n<li>Thick skin with ceruminous glands and hair follicles.</li>\n<li>Furuncles <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> here. <strong>(Option C)</strong></li>\n</ul>\n</li>\n<li><strong>Bony Part </strong>(Inner two-thirds, approximately 16 mm):\n\t\t\t\t<ul>\n<li>Thin skin extends over the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</li>\n<li>No hair or ceruminous glands.</li>\n<li>Isthmus makes foreign body removal difficult.</li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> collects debris in infections.</li>\n<li>Foramen of Huschke (in children) allows infection to spread.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Superior:</strong> Middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</li>\n<li><strong>Posterior: </strong>Mastoid air cells, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve</li>\n<li><strong>Inferior:</strong> <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">Parotid</span> gland</li>\n<li><strong>Anterior: </strong>Temporomandibular joint (TMJ)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8AMteTLVAS4bkkrxzYbD1741164462.mp3", "video": ""}, {"text": "In reconstructive surgical procedures for nasal bridge deformities, if septal cartilage is unavailable, which part of the external ear is most commonly used as an alternative source for cartilage grafts?", "options": [{"label": "A", "text": "Lobule", "correct": false}, {"label": "B", "text": "Tragus", "correct": false}, {"label": "C", "text": "Incisura terminalis", "correct": false}, {"label": "D", "text": "Conchal cartilage", "correct": true}], "correct_answer": "D. Conchal cartilage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nJrN9p6p34Jk27XWD7zU1738681923.png", "https://image.prepladder.com/content/MuSCTu2U0XkZmsBcI7dR1738681970.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GjhK17DIEIqsLaKUBO2v1741159704.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 33 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Match the following theories of the origin of cholesteatoma with their descriptions: 1. Habermann's theory a) Retraction pocket theory 2. Wittmacks theory b) Basal cell hyperplasia theory 3. Sade's theory c) Epithelial invasion theory 4. Ruedi's theory d) Metaplastic theory", "options": [{"label": "A", "text": "1-a, 2-b, 3-c, 4-d", "correct": false}, {"label": "B", "text": "1-c, 2-a, 3-d, 4-b", "correct": true}, {"label": "C", "text": "1-d, 2-b, 3-a, 4-c", "correct": false}, {"label": "D", "text": "1-b, 2-a, 3-d, 4-c", "correct": false}], "correct_answer": "B. 1-c, 2-a, 3-d, 4-b", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Theory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital theory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> cell remnants contributing to <span class=\"customMeta\" data-dictid=\"e43816c49b1692777184ac533b9107\">cholesteatoma</span> formation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Habermann's theory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Epithelial invasion theory</strong></li>\n<li>Epithelial growth from the <span class=\"customMeta\" data-dictid=\"4896e8326b169277719479df7d8eb2\">outer ear</span> into the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> through perforations contributes to cholesteatoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wittmaack’s theory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Retraction pocket theory</strong></li>\n<li>Retraction of the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> occurs in the <span class=\"customMeta\" data-dictid=\"d451dc2fa616927771825c26632142\">attic</span> or <span class=\"customMeta\" data-dictid=\"18ea7646491692777196c2509104c9\">posterosuperior</span> <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa.</li>\n<li>Stratified <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> lines the outer membrane.</li>\n<li>Invagination forms a <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> pocket, acting as a <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> for <span class=\"customMeta\" data-dictid=\"d0e68b82ed1692777190fa10f7d4ba\">keratin</span> buildup.</li>\n<li>The accumulation of <span class=\"customMeta\" data-dictid=\"d0e68b82ed1692777190fa10f7d4ba\">keratin</span> leads to the formation of a cholesteatoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sade's theory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Metaplastic theory</strong></li>\n<li>Metaplasia of <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> into <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> due to repeated infections leads to cholesteatoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ruedi's theory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Basal cell <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> theory</strong></li>\n<li>Basal cell <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> in the skin's <span class=\"customMeta\" data-dictid=\"a0e5fdc156169277718879843a6ede\">germinal</span> layer leads to keratinizing <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> formation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NAegefbrsovC96EanOwQ1746294072.mp3", "video": ""}, {"text": "A 5-year-old child is diagnosed with Congenital cholesteatoma. According to Levenson's criteria, which factor is NOT used to diagnose this condition?", "options": [{"label": "A", "text": "Whitish mass behind a normal tympanic membrane", "correct": false}, {"label": "B", "text": "Intact pars flaccida and pars tensa", "correct": false}, {"label": "C", "text": "Family history of Congenital Cholesteatoma", "correct": true}, {"label": "D", "text": "No prior ear surgeries", "correct": false}], "correct_answer": "C. Family history of Congenital Cholesteatoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classification of Cholesteatoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital Cholesteatoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired Cholesteatoma</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"e43816c49b1692777184ac533b9107\">cholesteatoma</span> arises from embryonic <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> cell rests.</li>\n<li>It can occur in the middle ear, <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> apex, or <span class=\"customMeta\" data-dictid=\"d96ff08a3316927771845ceebabe4b\">cerebellopontine</span> angle.</li>\n<li>In the middle ear, it presents as a white mass behind an intact <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</li>\n<li>It<strong> causes conductive hearing loss.</strong></li>\n<li>It may be discovered during routine exams or myringotomy.</li>\n<li>It can spontaneously rupture, leading to ear <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> similar to chronic <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media (CSOM).</li>\n<li>Diagnosed using <strong>Levenson's criteria</strong>:\n\t\t\t\t<ul>\n<li>Presence of a whitish mass behind a normal <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane; <strong>(Option A ruled out)</strong></li>\n<li>An intact <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> flaccida and <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa; <strong>(Option B ruled out)</strong></li>\n<li>No previous history of ear <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> or perforation;</li>\n<li>No prior ear surgeries; <strong>(Option D ruled out)</strong></li>\n<li>Ruling out conditions such as <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> atresia, <span class=\"customMeta\" data-dictid=\"9ab9c0fe2f169277719065b8b974d7\">intramembranous</span> cholesteatoma, or giant cholesteatoma.</li>\n<li>A history of <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media was not ruled out.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>Primary <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">Acquired</span> Cholesteatoma</u></strong></p>\n<p>Occurs <strong>without a history</strong> of prior <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media or a preexisting perforation. Its <span class=\"customMeta\" data-dictid=\"ac6679d0161692777188bcd44ae041\">genesis</span> is attributed to three main theories:</p>\n<p><strong>(a) <span class=\"customMeta\" data-dictid=\"4ae704fdbb1692777190fb609e2290\">Invagination</span> of <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> flaccida</strong>: Persistent <span class=\"customMeta\" data-dictid=\"befa0a72121692777193663f2ca836\">negative pressure</span> causes <strong>retraction and accumulation of <span class=\"customMeta\" data-dictid=\"d0e68b82ed1692777190fa10f7d4ba\">keratin</span> debris</strong>, leading to an expanding cholesteatoma.</p>\n<p><strong>(b) <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">Basal</span> cell hyperplasia</strong>: <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">Proliferation</span> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cells in the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> flaccida due to infections results in <span class=\"customMeta\" data-dictid=\"e43816c49b1692777184ac533b9107\">cholesteatoma</span> formation and <span class=\"customMeta\" data-dictid=\"d451dc2fa616927771825c26632142\">attic</span> perforation.</p>\n<p><strong>(c) <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">Squamous</span> metaplasia</strong>: Normal <span class=\"customMeta\" data-dictid=\"d451dc2fa616927771825c26632142\">attic</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> transforms into keratinizing <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> due to <span class=\"customMeta\" data-dictid=\"4e02cdf6641692777199b3cc3b7237\">subclinical</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><u>Secondary <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">Acquired</span> Cholesteatoma</u></strong></p>\n<p>Occurs<strong> with a preexisting perforation</strong> in the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa, often a <span class=\"customMeta\" data-dictid=\"18ea7646491692777196c2509104c9\">posterosuperior</span> marginal or large central perforation. Its development is attributed to:</p>\n<p><strong>(a) Migration of <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> epithelium: </strong>Keratinizing <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> from the <span class=\"customMeta\" data-dictid=\"b9a0fc0e19169277718759be7a9732\">external ear</span> or <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> migrates through the <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> into the middle ear.</p>\n<p><strong>(b) Metaplasia:</strong> Repeated infections cause the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> to transform into keratinizing <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> through the perforation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" custommeta\"=\"\" data-author=\"Kuo 郭錦龍, Ken Chin-Lung &amp; Shiao, An-Suey &amp; Yung, Matthew &amp; Sakagami, Masafumi &amp; Sudhoff, Holger &amp; Wang, Chih-Hung &amp; Hsu, Chyong-Hsin &amp; Lien, Chiang-Feng. (2015). Updates and Knowledge Gaps in &lt;span class=\" data-dictid=\"e43816c49b1692777184ac533b9107\"/>Cholesteatoma Research. BioMed Research International. 2015. 10.1155/2015/854024. \" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/a-Congenital-cholesteatoma-anterosuperior-quadrant-of-eardrum-left-ear-A-white-mass_fig1_273145597\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/Z7Ph6uc0ndszYmKs5KrR1738670889.png\" width=\"400\" /&gt;</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" custommeta\"=\"\" data-author=\"Kuo 郭錦龍, Ken Chin-Lung &amp; Shiao, An-Suey &amp; Yung, Matthew &amp; Sakagami, Masafumi &amp; Sudhoff, Holger &amp; Wang, Chih-Hung &amp; Hsu, Chyong-Hsin &amp; Lien, Chiang-Feng. (2015). Updates and Knowledge Gaps in &lt;span class=\" data-dictid=\"e43816c49b1692777184ac533b9107\"/>Cholesteatoma Research. BioMed Research International. 2015. 10.1155/2015/854024. \" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/a-Acquired-cholesteatoma-of-attic-in-the-left-ear-arrow-Accumulation-of-debris_fig3_273145597\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/kfK2Y1O4X602F2ZRTusT1738670939.png\" width=\"400\" /&gt;</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YWtCpyo1yzKEZ2Iy0zqn1746294334.mp3", "video": ""}, {"text": "A patient with chronic suppurative otitis media reports that their hearing improves when the ear is discharging compared to when it is dry. Which phenomenon best explains this observation?", "options": [{"label": "A", "text": "Cholesteatoma hearer effect", "correct": false}, {"label": "B", "text": "Round window shielding effect", "correct": true}, {"label": "C", "text": "Ossicular chain erosion", "correct": false}, {"label": "D", "text": "Both A &amp;amp; B", "correct": false}], "correct_answer": "B. Round window shielding effect", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lft4xa3V1hJZ9DoF4Lvc1746295411.mp3", "video": ""}, {"text": "Which is the most common site of origin for cholesteatoma?", "options": [{"label": "A", "text": "Sinus tympani", "correct": false}, {"label": "B", "text": "Prussac's space", "correct": true}, {"label": "C", "text": "Oval window niche", "correct": false}, {"label": "D", "text": "Pars tensa", "correct": false}], "correct_answer": "B. Prussac's space", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/E9U9fexYCUCALD1Yv2Ur1737363201.png", "https://image.prepladder.com/content/a42YklZw5h1JdIL7mVJO1737363248.png"], "explanation": "\n<p><strong>References:</strong></p>\n<ul><li>↳ Chronic Draining Ear and Cholesteatoma Recidivism- PMC</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GSVJLmA6ZBy7aZmfBWjM1746295658.mp3", "video": ""}, {"text": "A 7-year-old child presents with a sensation of fullness. The child also reports occasional hearing loss. On otoscopy, a whitish mass behind the tympanic membrane is seen. Based on the information provided, which of the following is least likely to be a consequence of this patient’s diagnosis?", "options": [{"label": "A", "text": "Bone destruction due to release of enzymes", "correct": false}, {"label": "B", "text": "Bone destruction due to pressure necrosis", "correct": true}, {"label": "C", "text": "Extension into the aditus and mastoid", "correct": false}, {"label": "D", "text": "Destruction of the ear ossicles", "correct": false}], "correct_answer": "B. Bone destruction due to pressure necrosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vozxnQQBNcrJx8S5hxVu1746641425.mp3", "video": ""}, {"text": "Which is the correct order of ossicular erosion in cholesteatoma , from most common to least common?", "options": [{"label": "A", "text": "Incus &amp;gt; Stapes &amp;gt; Malleus", "correct": true}, {"label": "B", "text": "Stapes &amp;gt; Incus &amp;gt; Malleus", "correct": false}, {"label": "C", "text": "Incus &amp;gt; Malleus &amp;gt; Stapes", "correct": false}, {"label": "D", "text": "Malleus &amp;gt; Incus &amp;gt; Stapes", "correct": false}], "correct_answer": "A. Incus &gt; Stapes &gt; Malleus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rF7etNo8O3weUqViSfv71746296218.mp3", "video": ""}, {"text": "A 45 year out female presents with persistent ear discharge, hearing loss, and a feeling of fullness in the ear. Upon examination, the otolaryngologist performs an otoscopic examination, which reveals an abnormal growth in the ear canal. Which diagnostic test is most useful for assessing the extent of her condition and guiding surgical planning?", "options": [{"label": "A", "text": "Video-Otoscopy", "correct": false}, {"label": "B", "text": "High-resolution CT", "correct": true}, {"label": "C", "text": "Rinne Test", "correct": false}, {"label": "D", "text": "Diffusion-weighted MRI", "correct": false}], "correct_answer": "B. High-resolution CT", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1IeyVDpJYZt3WTe0UhIk1746296405.mp3", "video": ""}, {"text": "Which of the following statements about the treatment of cholesteatoma is false?", "options": [{"label": "A", "text": "Canal Wall Down Mastoidectomy involves removing of posterior canal wallto create an open cavity.", "correct": false}, {"label": "B", "text": "Tympanoplasty for cholesteatoma repair may use synthetic prostheses to repair the ossicles.", "correct": false}, {"label": "C", "text": "William Wilde's incision is made approximately 3 cm in front of the ear.", "correct": true}, {"label": "D", "text": "Canal Wall Up Mastoidectomy involves preserving the posterior canal wall.", "correct": false}], "correct_answer": "C. William Wilde's incision is made approximately 3 cm in front of the ear.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xgsTzzgfP0qV4CwaASMH1738671482.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KMQn90F8nTmSrys2gKMG1746296718.mp3", "video": ""}, {"text": "A patient with cholesteatoma is considering surgical options. Which of the following is a characteristic of a canal wall-up procedure compared to a canal wall-down procedure?", "options": [{"label": "A", "text": "Requires regular cleaning of the mastoid cavity by a doctor", "correct": false}, {"label": "B", "text": "Has a lower risk of residual cholesteatoma", "correct": false}, {"label": "C", "text": "Allows for easier hearing aid fitting", "correct": true}, {"label": "D", "text": "The patients are advised not to swim due to the risk of ear infections.", "correct": false}], "correct_answer": "C. Allows for easier hearing aid fitting", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Canal Wall Up</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Canal Wall Down</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a type of <span class=\"customMeta\" data-dictid=\"12d9c7a4041692777191aa892d206f\">mastoidectomy</span> in which the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> bony <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> wall is preserved. This maintains the natural <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> of the ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> and middle ear.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is a <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedure in which the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> and superior bony walls of the ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> are removed. This creates an open <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> that connects the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and mastoid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recurrence of Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High rate of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> or <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> cholesteatoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low rate of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> or <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> <span class=\"customMeta\" data-dictid=\"e43816c49b1692777184ac533b9107\">cholesteatoma</span> <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Postoperative Care</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Does not require routine cleaning</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires regular cleaning of the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> (once or twice a year) <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hearing Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Easy to wear a hearing aid, if needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Difficult to fit a <span class=\"customMeta\" data-dictid=\"1a6d0ff7891692777188ad0e931a82\">hearing aid</span> due to large <span class=\"customMeta\" data-dictid=\"6da3f0528c1692777192e9b608d735\">meatus</span> and <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient Limitations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No limitations to activities like swimming.</li>\n<li>The patient requires a second-look surgery 6 months later to rule out <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> cholesteatoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The patient is advised to not participate in activities like swimming as it can lead to <strong>infection of the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> cavity.</strong></li>\n<li>There is no need for second-look surgery. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wWCz67KD44JnqoXADlxx1746296930.mp3", "video": ""}, {"text": "A patient presents with a long-standing ear infection characterised by scanty, purulent, foul-smelling discharge and a marginal perforation of the tympanic membrane. The patient also shows signs of a red and fleshy polyp. What is the most likely diagnosis of this patient?", "options": [{"label": "A", "text": "Tubotympanic CSOM", "correct": false}, {"label": "B", "text": "Atticoantral CSOM", "correct": true}, {"label": "C", "text": "Acute Otitis Media", "correct": false}, {"label": "D", "text": "Serous Otitis Media", "correct": false}], "correct_answer": "B. Atticoantral CSOM", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:646px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tubotympanic CSOM</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign or Safe CSOM.</li>\n<li>Affects the antero-inferior region of the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> (eustachian tube and mesotympanum).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Profuse, mucoid, odourless discharge</li>\n<li>Central perforation</li>\n<li>Pale <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> (if present)</li>\n<li>Uncommon granulations</li>\n<li>Rarely associated with cholesteatoma.</li>\n<li>Rare complications</li>\n<li>Mild to moderate conductive hearing loss</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atticoantral CSOM</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unsafe or Dangerous CSOM.</li>\n<li>Affects the <span class=\"customMeta\" data-dictid=\"18ea7646491692777196c2509104c9\">posterosuperior</span> region of the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> (attic, antrum, and mastoid).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Scanty, purulent, foul-smelling discharge</li>\n<li>Attic or marginal perforation</li>\n<li>Common granulations due to osteitis</li>\n<li>Red and <span class=\"customMeta\" data-dictid=\"384d0cc3641692777202e927a4d222\">fleshy</span> <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> (if present)</li>\n<li>Frequently associated with cholesteatoma.</li>\n<li>Common complications</li>\n<li>Conductive or mixed hearing loss</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/C5rIcR290yTMtla7O5WY1746297130.mp3", "video": ""}, {"text": "Which examination method is most effective for visualising a suspected cholesteatoma and assessing the condition of the ossicles in a patient with CSOM?", "options": [{"label": "A", "text": "Otoscope", "correct": false}, {"label": "B", "text": "CT Scan of Temporal Bone", "correct": false}, {"label": "C", "text": "Examination Under a Microscope", "correct": true}, {"label": "D", "text": "Tuning Fork Tests", "correct": false}], "correct_answer": "C. Examination Under a Microscope", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination Under a <span class=\"customMeta\" data-dictid=\"195d6a11ca16927771927a92617498\">Microscope</span> (Otomicroscopy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Provides a detailed view compared to an otoscope. <strong>(Option A ruled out)</strong></li>\n<li>Identifies discharge, cholesteatoma, <span class=\"customMeta\" data-dictid=\"d01ba0b780169277719475443354eb\">ossicle</span> condition, granulations, and signs of bone erosion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tuning Fork Tests and Audiogram</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>An <span class=\"customMeta\" data-dictid=\"d12f3f1a9c1692777182267e3c9dc6\">audiogram</span> identifies the type and extent of <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> (conductive, sensorineural, or mixed).</li>\n<li>Tuning fork tests (Rinne, Weber, Schwabach) <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between conductive and <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> hearing loss.</li>\n<li>Usually, <span class=\"customMeta\" data-dictid=\"2b8e87cc481692777184e49d44fc10\">CHL</span> but SNHL may also be present in long-standing cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-Ray Mastoids/High-Resolution <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT Scan</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Bone</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Determines the extent of bone destruction and <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> pneumatization.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> helps identify low-lying <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> or anteposed <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> sinus, relevant for <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> planning.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture and Sensitivity of Ear Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Identifies specific bacteria causing the infection.</li>\n<li>Guides appropriate <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wkKof4YUjofow6S3j6D51746297314.mp3", "video": ""}, {"text": "Which of the following is a Canal wall-down procedure commonly performed in the surgical treatment of Atticoantral Chronic Suppurative Otitis Media (CSOM)?", "options": [{"label": "A", "text": "Intact Canal Wall Mastoidectomy", "correct": false}, {"label": "B", "text": "Tympanoplasty", "correct": false}, {"label": "C", "text": "Modified Radical Mastoidectomy", "correct": true}, {"label": "D", "text": "Atticotomy", "correct": false}], "correct_answer": "C. Modified Radical Mastoidectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Fm24IPOuoR0Tfyer8eqh1746298286.mp3", "video": ""}, {"text": "Which of the following describes the characteristic features of inactive squamosal disease in CSOM?", "options": [{"label": "A", "text": "Presence of cholesteatoma with mucopurulent discharge", "correct": false}, {"label": "B", "text": "Permanent perforation of the pars tensa with no active inflammation", "correct": false}, {"label": "C", "text": "The presence of retraction pockets with no active discharge", "correct": true}, {"label": "D", "text": "Healed tympanic membrane with tympanosclerosis and conductive hearing loss", "correct": false}], "correct_answer": "C. The presence of retraction pockets with no active discharge", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:493px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Active Mucosal Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Perforation of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa.</li>\n<li>Inflammation of the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> mucosa.</li>\n<li>Mucopurulent discharge.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Inactive Mucosal Disease </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Permanent <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa.</li>\n<li>Permanent perforation: <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">Fusion</span> of <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> and mucosa.</li>\n<li>No active <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> or discharge.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Healed <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> Media</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Healed but atrophic <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane</li>\n<li>Prone to retraction</li>\n<li>Tympanosclerosis may be present</li>\n<li>Conductive hearing loss</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:491px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Active <span class=\"customMeta\" data-dictid=\"737d377e061692777199508424034e\">Squamosal</span> Disease</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of cholesteatoma.</li>\n<li>Purulent, offensive <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> present.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Inactive <span class=\"customMeta\" data-dictid=\"737d377e061692777199508424034e\">Squamosal</span> Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> pockets in the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</li>\n<li>No active discharge.</li>\n<li>But <span class=\"customMeta\" data-dictid=\"d0e68b82ed1692777190fa10f7d4ba\">keratin</span> debris in <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> pockets can trigger infection and discharge.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6pYqG4sFCmnllxDaRzfN1746298476.mp3", "video": ""}, {"text": "Which of the following is a typical characteristic of tubercular otitis media?", "options": [{"label": "A", "text": "Persistent and severe ear pain", "correct": false}, {"label": "B", "text": "Multiple perforations of the tympanic membrane", "correct": true}, {"label": "C", "text": "Sudden onset of symptoms with rapid progression", "correct": false}, {"label": "D", "text": "Mild hearing loss", "correct": false}], "correct_answer": "B. Multiple perforations of the tympanic membrane", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gqG0BkdfyOLcFXtnp5N21738672016.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RgekrfzlwLL5kd7Dst5T1746298626.mp3", "video": ""}, {"text": "A 10-year-old child presents with hearing loss and a retracted tympanic membrane on otoscopic examination. The pars flaccida is completely retracted, and the retraction pocket is fully visible, and the tympanic membrane is in contact with the malleus. According to the Tos &amp;amp; Poulsen classification, what is the appropriate classification for this retraction?", "options": [{"label": "A", "text": "Type 0", "correct": false}, {"label": "B", "text": "Type I", "correct": false}, {"label": "C", "text": "Type II", "correct": true}, {"label": "D", "text": "Type III", "correct": false}], "correct_answer": "C. Type II", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wUQefqdSuKNrw1jDZJrT1747809089.mp3", "video": ""}, {"text": "A 30 year old patient with chronic otitis media presents with a perforated tympanic membrane and erosion of the malleus. The surgeon plans to repair the tympanic membrane and place a graft on the remaining malleus. According to Wullstein's classification, which type of tympanoplasty is being performed?", "options": [{"label": "A", "text": "Type I", "correct": true}, {"label": "B", "text": "Type II", "correct": false}, {"label": "C", "text": "Type III", "correct": false}, {"label": "D", "text": "Type IV", "correct": false}], "correct_answer": "A. Type I", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myringoplasty: Repair of a <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> using a <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> over the malleus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed on the <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> and <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed directly on the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> head in absence of the <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> (myringostapediopexy or <span class=\"customMeta\" data-dictid=\"e03b2f95ab1692777184437bf8f3c5\">columella</span> tympanoplasty).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed over the <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> in the absence of the Malleus, <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">Incus</span> and <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">Stapes</span> suprastructure (cavum minor), allowing sound to act directly on the footplate.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fenestration operation: Creation of a new window on the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> semicircular canal, creating an <span class=\"customMeta\" data-dictid=\"d65e6c0e1616927771818ab537250d\">alternate</span> <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> for the sound to travel instead of the natural pathway.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"><strong>Type VI</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">Sonoinversion: <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">Graft</span> placed over the round window, reversing the <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> of sound transmission (Sound now travels from <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">Oval</span> window to Round window)</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HrTz4GvHsmL9DrNzxbn51746642850.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "This image shows a patient with complaints of a small, asymptomatic, pit-like opening located just anterior to the ear canal with a history of pus discharge from the same area. The deformity is due to incomplete fusion of which arch?", "options": [{"label": "A", "text": "1st brachial arch", "correct": true}, {"label": "B", "text": "2nd brachial arch", "correct": false}, {"label": "C", "text": "4th and 6th brachial arches.", "correct": false}, {"label": "D", "text": "3rd brachial arch", "correct": false}], "correct_answer": "A. 1st brachial arch", "question_images": ["https://image.prepladder.com/content/c0WGyS0pkXi7dApVlxoA1738724604.png"], "explanation_images": ["https://image.prepladder.com/content/jRMlCQrINSprpYcfvvZv1738724684.png", "https://image.prepladder.com/content/O8IBqS9j8HNpmzflVELU1738724736.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ad7iUiUs7b5prhxglebQ1745132071.mp3", "video": ""}, {"text": "A professional boxer presents with a swollen and bruised ear. The condition is most likely diagnosed as:", "options": [{"label": "A", "text": "Hematoma of ear", "correct": true}, {"label": "B", "text": "Perichondritis", "correct": false}, {"label": "C", "text": "Otitis Externa", "correct": false}, {"label": "D", "text": "Otomycosis", "correct": false}], "correct_answer": "A. Hematoma of ear", "question_images": ["https://image.prepladder.com/content/4R4r0vXKzREFwBMU7Ymp1738724816.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/t4qsUIICtqTYY8sF7OF81745132249.mp3", "video": ""}, {"text": "A 65-year-old male presents with a painful, swollen right ear few days after an injury. The ear has a warm, red appearance, and the patient reports that the pain began shortly after the trauma. Based on the clinical image provided. Which of the following conditions is most consistent with this presentation?", "options": [{"label": "A", "text": "Perichondritis", "correct": true}, {"label": "B", "text": "Cellulitis", "correct": false}, {"label": "C", "text": "Otitis externa", "correct": false}, {"label": "D", "text": "Furunculosis", "correct": false}], "correct_answer": "A. Perichondritis", "question_images": ["https://image.prepladder.com/content/Npq3yVJkWSeJ7Br7y0951738724898.png"], "explanation_images": ["https://image.prepladder.com/content/lItDI0BECKUkmsC75Fb81738724950.png", "https://image.prepladder.com/content/QGKarVXC8wTSYZUti9Gx1738724996.png", "https://image.prepladder.com/content/07sClNnwiKmcGDb32BuM1738725049.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fjSrkCv8onIe2U885qhW1745133337.mp3", "video": ""}, {"text": "A middle-aged lady presents with the lesion given below. Which of the following statements is false about the given condition?", "options": [{"label": "A", "text": "It is caused by an overproduction of collagen during the healing process.", "correct": false}, {"label": "B", "text": "They are typically painful and tender to the touch.", "correct": true}, {"label": "C", "text": "There are high chances of recurrence.", "correct": false}, {"label": "D", "text": "It can appear in areas where the skin has been subjected to trauma or surgery.", "correct": false}], "correct_answer": "B. They are typically painful and tender to the touch.", "question_images": ["https://image.prepladder.com/content/DPLULI91QuazW58EgNUJ1738725120.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mSEd2TpMekgSJOJ7HOGG1745133608.mp3", "video": ""}, {"text": "A 3-year-old child is diagnosed with congenital atresia of the external auditory canal. The child also has microtia. Which of the following statements is true about the condition?", "options": [{"label": "A", "text": "Due to the failure of the tympanic membrane development.", "correct": false}, {"label": "B", "text": "Typically involves abnormalities in the middle ear, inner ear, and possibly other structures.", "correct": true}, {"label": "C", "text": "Hearing aids or bone conduction devices are generally ineffective for this condition.", "correct": false}, {"label": "D", "text": "Surgical reconstruction is commonly performed before age 5.", "correct": false}], "correct_answer": "B. Typically involves abnormalities in the middle ear, inner ear, and possibly other structures.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tmZ99g2Q6DaMnZM6IRL51738725195.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/i69fwFRbhrcuiXLzEkms1745134028.mp3", "video": ""}, {"text": "Which of the following statements about otitis externa is FALSE?", "options": [{"label": "A", "text": "Bacterial furuncle is commonly caused by Staphylococcus aureus and affects the cartilaginous part of the ear canal.", "correct": false}, {"label": "B", "text": "Swimmers are at higher risk of developing chronic otitis externa.", "correct": false}, {"label": "C", "text": "Surgical excision is the definitive treatment for acute diffuse otitis externa.", "correct": true}, {"label": "D", "text": "In acute diffuse otitis externa, ear toilet and topical antibiotics are essential for initial management.", "correct": false}], "correct_answer": "C. Surgical excision is the definitive treatment for acute diffuse otitis externa.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tTd7ajwJjiwsKvZx0TfX1738725302.png", "https://image.prepladder.com/content/NGuavKzqdyoIvIaDR7cX1738725348.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>OTITIS EXTERNA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Localized <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> Externa (Bacterial Furuncle)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diffuse <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> Externa</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staphylococcal </strong>infection of the hair <span class=\"customMeta\" data-dictid=\"b0c3f6b8901692777203d0446fe1f4\">follicle</span> in the <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> part of the external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal. <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seen in hot, humid climates, often in swimmers. <strong>(Option B)</strong></li>\n<li>Predisposing factors: Trauma (e.g., from scratching or cleaning the ear) and invasion by pathogens (<em>Staphylococcus aureus, Pseudomonas</em>, etc.).</li>\n<li>Can also be secondary to <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> infections or allergic reactions to <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> ear drops.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe pain and tenderness, often disproportionate to the <span class=\"customMeta\" data-dictid=\"440bf2645b1692777203c1242486d6\">furuncle</span> size.</li>\n<li>Pain aggravated by <span class=\"customMeta\" data-dictid=\"7aafd1d2571692777195e9d2250eab\">pinna</span> and jaw movements.</li>\n<li>Enlarged and tender <span class=\"customMeta\" data-dictid=\"eedcc2305e1692777195019d25d11a\">periauricular</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute phase</strong>: Burning sensation, severe pain (worsened by jaw movement), <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> progressing to purulent, meatal swelling, conductive hearing loss, and tender <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic phase</strong>: Persistent irritation, itching, scanty <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> forming crusts, thick and swollen meatal skin with potential for stenosis.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early cases:</strong> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">Systemic</span> antibiotics, analgesics, and local heat application.</li>\n<li>Ichthammol glycerine ear pack to reduce pain and edema.</li>\n<li>If <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> forms, <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> are necessary.</li>\n<li><strong>Recurrent cases: </strong>Rule out diabetes and investigate <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> vestibules or skin <span class=\"customMeta\" data-dictid=\"8bd72cc36b1692777199668da84fcd\">staphylococcal</span> infections.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute phase:</strong> <strong>(Option D)</strong></p>\n<ul>\n<li><strong>Ear toilet</strong>: Removal of <span class=\"customMeta\" data-dictid=\"2df02c8a091692777187db6df500a1\">exudate</span> and debris using dry mopping, suction, or irrigation.</li>\n<li><strong>Medicated wicks</strong>: Antibiotic-steroid soaked <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> wick for 2-3 days, followed by ear drops.</li>\n<li><strong>Antibiotics</strong>: <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">Broad-spectrum</span> <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> antibiotics for <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> and lymphadenitis.</li>\n<li><strong>Analgesics</strong>: For pain relief.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic phase:</strong></p>\n<ul>\n<li>Ichthammol glycerine-soaked wick to reduce <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> followed by ear toilet.</li>\n<li>Topical antibiotic-steroid cream for itching.</li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and split-skin <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> for chronic stenotic <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> externa resistant to medical treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Michael Hawke, Peter Kwok\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Extemal-Canal-Furuncle_fig1_49782564\" data-tags=\"\" height=\"490\" src=\"https://image.prepladder.com/content/tTd7ajwJjiwsKvZx0TfX1738725302.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"P. Schaefer, R. Baugh\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Acute-otitis-externa%3A-an-update.-Schaefer-Baugh/0447626f119bbd3caa754827583923c25d76b838/figure/3\" data-tags=\"\" height=\"494\" src=\"https://image.prepladder.com/content/NGuavKzqdyoIvIaDR7cX1738725348.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DYjS22VYYkh525OCXdxS1746293816.mp3", "video": ""}, {"text": "A 68-year-old diabetic male has severe ear pain, purulent discharge, facial weakness, granulation tissue in the ear canal, and bony destruction shown on CT. Culture grows Pseudomonas aeruginosa. What is the most appropriate initial treatment?", "options": [{"label": "A", "text": "Topical antibiotics with ear canal cleaning only", "correct": false}, {"label": "B", "text": "Strict Diabetes control with surgical debridement", "correct": false}, {"label": "C", "text": "IV gentamicin with ticarcillin for 6 weeks with strict glucose control", "correct": true}, {"label": "D", "text": "Surgical debridement followed by short-term antibiotic therapy", "correct": false}], "correct_answer": "C. IV gentamicin with ticarcillin for 6 weeks with strict glucose control", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r1Pe1BBKOLUJ8oYfQCMh1738725423.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/d4hpxYzYlKsl9HToiosX1746293594.mp3", "video": ""}, {"text": "A 32-year-old man visits the clinic with complaints of severe itching, discomfort, and a foul-smelling watery discharge from his ear. On otoscopic examination, the ear canal shows a fungal mass that appears black and filamentous. He has recently used topical antibiotics for a different ear condition. What is the most appropriate initial management for this patient?", "options": [{"label": "A", "text": "Topical antibiotic ear drops for another 3 weeks", "correct": false}, {"label": "B", "text": "Topical antifungal treatment with ear canal cleaning", "correct": true}, {"label": "C", "text": "Intravenous antifungal therapy", "correct": false}, {"label": "D", "text": "Ear canal irrigation with saline", "correct": false}], "correct_answer": "B. Topical antifungal treatment with ear canal cleaning", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SH21XC1aXhC5cUxTwNvA1738725497.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9Vy6rEiY7SXSOrBMHnMV1746293347.mp3", "video": ""}, {"text": "A 5-year-old child is brought to the emergency department after inserting a small button battery into their ear canal. The battery is visible on otoscopic examination, and the tympanic membrane appears intact. Which of the following is NOT a recommended method for removing the foreign body from the ear canal?", "options": [{"label": "A", "text": "Crocodile forceps removal", "correct": false}, {"label": "B", "text": "Syringing", "correct": true}, {"label": "C", "text": "Suction tipped catheters", "correct": false}, {"label": "D", "text": "Cyanoacrylate glue tipped applicator", "correct": false}], "correct_answer": "B. Syringing", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Insects (alive or dead)</li>\n<li>Cotton tips</li>\n<li>Paper</li>\n<li>Beads</li>\n<li>Button battery</li>\n<li>Food</li>\n<li>Stones</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ear pain or discomfort</li>\n<li>Hearing loss</li>\n<li>Tinnitus</li>\n<li>Vertigo (rare)</li>\n<li>Bleeding or <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (if trauma occurs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>History taking</li>\n<li>Otoscopic examination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Removal Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Irrigation/Syringing- </strong>Contraindicated in organic items and button batteries</li>\n<li>Suction<strong> (Option C)</strong></li>\n<li>Forceps or hook (Crocodile forceps) <strong>(Option A)</strong></li>\n<li>Cyanoacrylate <span class=\"customMeta\" data-dictid=\"ffd65f286616927771883be907f80a\">glue</span> tipped applicator<strong> (Option D)</strong></li>\n<li>Mineral oil/Lidocaine for <span class=\"customMeta\" data-dictid=\"29aeb05b801692777182f7407066be\">arthropod</span> removal</li>\n<li>Surgical removal (rare cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excoriations and lacerations of <span class=\"customMeta\" data-dictid=\"0be45e4f93169277718692dc3cee29\">EAC</span> skin</li>\n<li>Tympanic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> perforation</li>\n<li>Ossicular chain damage</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qKZzhnSssMlnDNTUeFuV1746291752.mp3", "video": ""}, {"text": "A 45-year-old patient presents with complaints of a feeling of fullness in the ear, occasional itching, and decreased hearing. Otoscopic examination reveals a large, hard, and waxy plug, Pearly white in color and onion peel like layered pattern, in the ear canal. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Otitis externa", "correct": false}, {"label": "B", "text": "Impacted wax", "correct": false}, {"label": "C", "text": "Keratosis obturans", "correct": true}, {"label": "D", "text": "Foreign body", "correct": false}], "correct_answer": "C. Keratosis obturans", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/O6n8Qeunb7M2XfYHJhjt1738725581.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZK3HN3obxOCFaL8tFrOh1745508577.mp3", "video": ""}, {"text": "A 45-year-old woman presented with right-sided facial weakness. O/E, she has vesicles in the EAC as shown in the image. Identify the wrong statement about this condition.", "options": [{"label": "A", "text": "Ebstein virus is the causative organism", "correct": true}, {"label": "B", "text": "Shows a poor prognosis", "correct": false}, {"label": "C", "text": "Antivirals along with steroids are the mainstay treatment", "correct": false}, {"label": "D", "text": "Involvement of the VIIth and VIIIth nerves", "correct": false}], "correct_answer": "A. Ebstein virus is the causative organism", "question_images": ["https://image.prepladder.com/content/ZYmeI7hQREeU2Q6mVZQe1738725651.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bJWUaVYUSsYAVfl7kOuL1745508303.mp3", "video": ""}, {"text": "A 28-year-old patient presents with severe ear pain, hearing loss, and a sudden onset of blisters on the eardrum. The patient reports symptoms of a recent upper respiratory infection. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myringitis Bullosa Hemorrhagic", "correct": true}, {"label": "B", "text": "Acute otitis media", "correct": false}, {"label": "C", "text": "Ramsay Hunt syndrome", "correct": false}, {"label": "D", "text": "Cholesteatoma", "correct": false}], "correct_answer": "A. Myringitis Bullosa Hemorrhagic", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YwGsmiTqAvAyRtDMBDyX1738725743.png", "https://image.prepladder.com/content/iUHKmxKyl0N51d5GLpF01738725787.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xUgq0ajyHPXdEKU6M9AC1745508120.mp3", "video": ""}, {"text": "All the following are true statements about the Eustachian tube except-", "options": [{"label": "A", "text": "It connects the nasopharynx to the middle ear by opening the anterior wall of the middle ear.", "correct": false}, {"label": "B", "text": "The total length is 36mm", "correct": false}, {"label": "C", "text": "Its function is to maintain the middle ear pressure", "correct": false}, {"label": "D", "text": "Tensor veli palatini and tensor tympanii are the 2 muscles that help in opening the tube", "correct": true}], "correct_answer": "D. Tensor veli palatini and tensor tympanii are the 2 muscles that help in opening the tube", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:672px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adult</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Length</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13-18</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>36mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orientation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Horizontal, short, wide, and straight</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Angulated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cartilaginous part</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flaccid allowing easy reflex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rigid and hence remains closed often</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ostmann pad of fat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less in volume</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More in volume</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ventilatory function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poorly developed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Well developed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3FF5L8MwfDYmPEUqA5pI1745507802.mp3", "video": ""}, {"text": "A 30-year-old patient presents with a sensation of ear fullness and hearing their own voice loudly in their ear, especially when speaking or swallowing. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Patulous Eustachian tube", "correct": true}, {"label": "B", "text": "Otitis media with effusion", "correct": false}, {"label": "C", "text": "Meniere’s disease", "correct": false}, {"label": "D", "text": "Acoustic neuroma", "correct": false}], "correct_answer": "A. Patulous Eustachian tube", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xQ87XuaWNU6O8oYgJWbk1745507566.mp3", "video": ""}, {"text": "When managing barotrauma during a dive, which of the following actions is most appropriate to alleviate the symptoms and prevent further injury?", "options": [{"label": "A", "text": "Perform an immediate rapid ascent to the surface", "correct": false}, {"label": "B", "text": "Administer supplemental oxygen and maintain gradual ascent", "correct": true}, {"label": "C", "text": "Take over-the-counter pain medication", "correct": false}, {"label": "D", "text": "Use a hot compress on the affected area", "correct": false}], "correct_answer": "B. Administer supplemental oxygen and maintain gradual ascent", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bhFm3fbvodYK8VHdiA5o1745507414.mp3", "video": ""}, {"text": "All the statements are true about eustachian tube function tests, except:", "options": [{"label": "A", "text": "Catheterization is performed with the help of anesthesia", "correct": false}, {"label": "B", "text": "The principle of the Valsalva is to build negative pressure in the nasopharynx so that air enters the eustachian tube.", "correct": true}, {"label": "C", "text": "In radiological tests the time taken by the dye to reach the nasopharynx also indicates its clearance function", "correct": false}, {"label": "D", "text": "Tympanometry can be done both in patients with perforated or intact tympanic membranes", "correct": false}], "correct_answer": "B. The principle of the Valsalva is to build negative pressure in the nasopharynx so that air enters the eustachian tube.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kYdP7NYxh7xbRE4iYPDB1738725910.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FshUG3E1449RIbfGkND91745503574.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 17 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 10-year-old presents with recurrent episodes of facial swelling, particularly around her lips, along with a history of facial palsy. On examination, she also has a fissured tongue (lingua plicata) as shown below. Based on these clinical features, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Bell's Palsy", "correct": false}, {"label": "B", "text": "Sjögren's Syndrome", "correct": false}, {"label": "C", "text": "Melkersson-Rosenthal Syndrome", "correct": true}, {"label": "D", "text": "Ramsay Hunt Syndrome", "correct": false}], "correct_answer": "C. Melkersson-Rosenthal Syndrome", "question_images": ["https://image.prepladder.com/content/tnuJxJ1UPV0KkveYWZeZ1738727041.png"], "explanation_images": ["https://image.prepladder.com/content/U2F6F0KzjDRSfOrr9qcL1738727109.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RYasvfRwI2vzh5eoVi8c1745419092.mp3", "video": ""}, {"text": "A 52-year-old woman presents to the clinic with complaints of progressive hearing loss in her right ear with a ringing sensation over the past 8 months. On examination, she has a unilateral sensorineural hearing loss on the right side. An MRI scan of the brain with gadolinium contrast reveals a well-circumscribed, enhancing mass about 4cm in size at the cerebellopontine angle. What is the treatment of choice?", "options": [{"label": "A", "text": "Conventional radiotherapy", "correct": false}, {"label": "B", "text": "Surgery", "correct": true}, {"label": "C", "text": "X-knife surgery", "correct": false}, {"label": "D", "text": "CyberKnife", "correct": false}], "correct_answer": "B. Surgery", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treatment of choice.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> approach depends on the tumor size.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy</strong></p>\n<br/>\n\t\t\t </td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conventional <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> by external beam is not suitable due to low <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> tolerance to radiation.</li>\n<li>X-knife or <span class=\"customMeta\" data-dictid=\"49be0416121692777188dc8944b7bc\">Gamma</span> knife surgery:\n\t\t\t\t<ul>\n<li>Form of <span class=\"customMeta\" data-dictid=\"f3333542581692777199584fa789d9\">stereotactic</span> radiotherapy</li>\n<li>Focuses radiation on the tumor, minimizing the effect on surrounding normal tissue</li>\n<li>Arrests tumor growth and can reduce size</li>\n<li>Used for patients who refuse or are contraindicated for surgery, or with <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> tumor after surgery.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>CyberKnife - An improved version</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kv0n21FNl5XK1tdktciX1745423514.mp3", "video": ""}, {"text": "A 40-year-old male patient was diagnosed with Acoustic neuroma. Which among the following cranial nerve is the earliest to be involved in this condition?", "options": [{"label": "A", "text": "V", "correct": true}, {"label": "B", "text": "VI", "correct": false}, {"label": "C", "text": "IX", "correct": false}, {"label": "D", "text": "X", "correct": false}], "correct_answer": "A. V", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Age 40-60, both sexes equally affected</li>\n<li>Progressive <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> hearing loss, tinnitus</li>\n<li>Imbalance, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> numbness, <span class=\"customMeta\" data-dictid=\"2749f813cb16927771864616f3317f\">dysphagia</span> in later stages</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cranial Nerves Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>V: Earliest to be involved </strong><strong>(Option A)</strong>, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">Reduced</span> corneal sensitivity, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> numbness</li>\n<li><strong>VII:</strong> Hypoaesthesia, delayed blink reflex, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> lacrimation</li>\n<li><strong>X, XI:</strong> Dysphagia, hoarseness</li>\n<li>May involve other <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves as disease progress</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pure tone audiometry: High-frequency <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> loss, <strong>roll-over or decay</strong> phenomenon seen. (Roll over associated with <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> symptoms is called as <strong>Tulio phenomenon</strong>)</li>\n<li><strong>Speech audiometry:</strong> Poor discrimination</li>\n<li><strong>MRI with gadolinium: Gold standard</strong>, ice-cream <span class=\"customMeta\" data-dictid=\"1c42c9fe83169277718486ee5a82e9\">cone</span> appearance seen.</li>\n</ul>\n<p><img alt=\"\" custommeta\"=\"\" data-author=\"RadsWiki\" data-dictid=\"e8b3c606051692777201faf2a1a357\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"Vestibular-schwannoma-003 - &lt;span class=\"/>Vestibular schwannoma - Wikipedia\" data-tags=\"\" height=\"643\" src=\"https://image.prepladder.com/content/VAFezU3EBcfDqXek1Ba51738729188.png\" width=\"500\" /&gt;</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Surgery:</strong> Middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa, translabyrinthine, suboccipital, combined approach</li>\n<li><strong>Radiosurgery: </strong>Gamma knife, Cyberknife</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Meningioma, epidermoid, <span class=\"customMeta\" data-dictid=\"dd3534c97c16927771823c0d04f685\">arachnoid</span> cyst, metastases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/s3tACuBYmMDSDPdDO6oD1745423271.mp3", "video": ""}, {"text": "A 50-year-old female presented with hearing loss, tinnitus and vertigo. MRI showed the finding as shown. Choose the most likely origin nerve and the cell involved in this condition.", "options": [{"label": "A", "text": "Superior vestibular nerve - Neurons", "correct": false}, {"label": "B", "text": "Superior vestibular nerve - Schwann cells", "correct": false}, {"label": "C", "text": "Inferior vestibular nerve - Neurons", "correct": false}, {"label": "D", "text": "Inferior vestibular nerve - Schwann cells", "correct": true}], "correct_answer": "D. Inferior vestibular nerve - Schwann cells", "question_images": ["https://image.prepladder.com/content/QJAr5EetC6xAhY2lsEwv1738728802.png"], "explanation_images": ["https://image.prepladder.com/content/Cmw60LOurUH2mzCPqNBT1738728918.png", "https://image.prepladder.com/content/8Rs5SbAkVkQmhcshXjrg1738729053.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Constitutes 80% of <span class=\"customMeta\" data-dictid=\"d96ff08a3316927771845ceebabe4b\">cerebellopontine</span> angle tumors, 10% of all brain tumors</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign, slow-growing tumor of the VIIIth <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve; consists of <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cells with rod-shaped nuclei; <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> in neurofibromatosis</li>\n<li><strong>Characteristics:</strong> <strong>Antoni A- <span class=\"customMeta\" data-dictid=\"99179151b4169277718946a0f60df6\">hypercellular</span> area, Antoni B</strong>- <span class=\"customMeta\" data-dictid=\"73b13104341692777189355a61a196\">hypocellular</span> area, <strong>verocay bodies</strong> with <strong>nuclear palisading</strong> seen.</li>\n</ul>\n<img alt=\"\" data-author=\"Hodges, Tiffany R.; Karikari, Isaac O.; Nimjee, Shahid M.; Tibaleka, June; Cummings, Thomas J.; Radhakrishnan, Senthil; Friedman, Allan H.\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"Schwannoma with Antoni A and Antoni B areas - Schwannoma - Wikipedia\" data-tags=\"\" height=\"390\" src=\"https://image.prepladder.com/content/Cmw60LOurUH2mzCPqNBT1738728918.png\" width=\"500\"/><br/>\n<img alt=\"\" custommeta\"=\"\" data-author=\"Pezzali, Luíza Guazzelli; Rostirolla, Gabriela Francoes; Luiz, Carina Bauer; Gomes, Lúcio Brandão; Rivero, Raquel Camara; Valério, Edimárlei Gonsales; Vettorazzi, Janete\" data-dictid=\"4cbafab81b169277720112f56b0785\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"Antoni A area of schwannoma with &lt;span class=\"/>Verocay bodies - annotated - Schwannoma - Wikipedia\" data-tags=\"\" height=\"375\" src=\"https://image.prepladder.com/content/TKkmnPVbPynySVJrXSXx1738728995.png\" width=\"500\" /&gt;</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Arises from <strong>Schwann cells of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> </strong><strong>(Option D)</strong> &gt; Superior <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> &gt;&gt; Cochlear division of VIIIth nerve within internal <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal</li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"2\" src=\"https://image.prepladder.com/content/8Rs5SbAkVkQmhcshXjrg1738729053.png\" width=\"500\"><br/>\n\t\t\t </img></td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:604px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cochlear SNHL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retrocochlear SNHL</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hair cells are damaged mainly</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesion is of VIIth nerve or its central connections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recruitment is present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recruitment absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No significant tone decay</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tone <span class=\"customMeta\" data-dictid=\"6a867651ba1692777185bb15ba2f9c\">decay</span> is significant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SISI is positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SISI is negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bekesy shows no gap between I and C <span class=\"customMeta\" data-dictid=\"addd29dc5b1692777200a6caa8b28c\">tracing</span> (Type II)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bekesy shows wide gap between I and C tracings (type III)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Speech discrimination is not highly impaired (SDS) is low) and roll over phenomenon is not present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Speech discrimination is highly impaired (SDS very poor) and roII over phenomenon is present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subjective feeling of displacusis, <span class=\"customMeta\" data-dictid=\"b130bc5e0a16927771899a18c6abbc\">hyperacusis</span> or fullness in the ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No such sensation or feeling</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2gaCBtDKEuxSDQ58yEj41745422992.mp3", "video": ""}, {"text": "Post-parotidectomy, a patient presented with complaints of sweating over the cheek region upon chewing food as shown. Which statement is inappropriate?", "options": [{"label": "A", "text": "Abnormal innervation of greater auricular nerve with damaged facial nerve", "correct": true}, {"label": "B", "text": "Tympanic neurectomy is done for treating this", "correct": false}, {"label": "C", "text": "Starch iodide test is helpful in establishing a diagnosis", "correct": false}, {"label": "D", "text": "Interpositional flaps during surgery reduced the risk of this", "correct": false}], "correct_answer": "A. Abnormal innervation of greater auricular nerve with damaged facial nerve", "question_images": ["https://image.prepladder.com/content/bqWB3ogBGcdctMGNOgl81738728605.png"], "explanation_images": ["https://image.prepladder.com/content/rCnTrDHijA3waB6CFlZJ1677824730.svg", "https://image.prepladder.com/content/jTMDqWVbVx1Bo23Tv6ue1738728658.png", "https://image.prepladder.com/content/SUlTbouw6GluevkscEQ31738728716.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frey’s syndrome:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Faulty <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> of <strong>parasympathetic</strong> fibers of a<strong>uriculo-temporal nerve</strong> <strong>(Option A)</strong><strong> </strong>supplying sweat fibers of face following Parotid surgery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>gustatory <span class=\"customMeta\" data-dictid=\"8fab5233721692777199fc0bcd1210\">sweating</span> and flushing over angle of mandible</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Starch Iodide test <strong>(Option C)</strong></p>\n<p><img alt=\"\" data-author=\"JignaS Shah, VijayK Asrani\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Application-of-1-iodine-over-the-affected-area-a-application-of-starch-powder-over_fig4_321968580\" data-tags=\"\" height=\"222\" src=\"https://image.prepladder.com/content/SUlTbouw6GluevkscEQ31738728716.png\" width=\"500\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevention:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use of Interpositional flaps like Sternocleidomastoid <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> during surgery. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Botox injection, Tympanic neurectomy. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Crocodile <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> (gustatory lacrimation):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Faulty <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> of <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> fibers to the <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> gland.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> during eating</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tympanic neurectomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BGCYtjGHA3MoybEVh4on1745422813.mp3", "video": ""}, {"text": "A 32-year-old woman presented with a 6-week history of swelling of both cheeks as shown, redness of eyes and cough. She reported having difficulty moving the right side of her face. On examination, Angiotensin-converting enzyme levels were elevated. Lymph node biopsy showed the following. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Melkersson–Rosenthal syndrome", "correct": false}, {"label": "B", "text": "Lyme disease", "correct": false}, {"label": "C", "text": "Wegener’s granulomatosis", "correct": false}, {"label": "D", "text": "Heerfordt syndrome", "correct": true}], "correct_answer": "D. Heerfordt syndrome", "question_images": ["https://image.prepladder.com/content/eKcmninAi63VWylrrWXF1738728358.png"], "explanation_images": ["https://image.prepladder.com/content/9RyqsSpwwLAqC7INZEpY1738728422.png", "https://image.prepladder.com/content/96K0aopizhiMnoisgFO11738728473.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) </strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autoimmune <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> vasculitis.</li>\n<li>Granulomas in <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> tracts and kidneys.</li>\n<li>Facial nerve <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> with Sensorineural hearing loss.</li>\n<li><strong>Diagnosis:</strong> <strong>Elevated c-ANCA.</strong></li>\n<li>Treatment: Cyclophosphamide + steroids.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lyme Disease</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cause: <strong>Borrelia burgdorferi</strong>, Vector: <strong>Hard tick</strong>.</li>\n<li>Flu-like symptoms, <strong>erythema migrans</strong>, <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Hannah Garrison\" data-hash=\"\" data-license=\"CC BY-SA 2.5\" data-source=\"https://en.wikipedia.org/wiki/Erythema_migrans#/media/File:Bullseye_Lyme_Disease_Rash.jpg\" data-tags=\"\" height=\"586\" src=\"https://image.prepladder.com/content/96K0aopizhiMnoisgFO11738728473.png\" width=\"500\"/></p>\n\t\t\t <strong> Fig: <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">Erythema</span> migrans</strong>\n<ul>\n<li><strong>Diagnosis:</strong> Serologic testing.</li>\n<li><strong>Treatment:</strong> Doxycycline or amoxicillin, if contra-indicated - Azithromycin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ramsay Hunt Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> with erythematous <strong>vesicular <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> on ear</strong> or mouth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Melkersson–Rosenthal Syndrome</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy, <strong>furrowed tongue</strong>, faciolabial edema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Moebius Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"133b86a0a516927771809ea08682e8\">agenesis</span> of VI and VII <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve nuclei.</li>\n<li>Seen with <strong>Misoprostol</strong> teratogenicity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/enEhEX6Djs5kjgi35UUx1745420701.mp3", "video": ""}, {"text": "The Blink Reflex test primarily evaluates the function of which two cranial nerves?", "options": [{"label": "A", "text": "Cranial nerves II and V", "correct": false}, {"label": "B", "text": "Cranial nerves III and VII", "correct": false}, {"label": "C", "text": "Cranial nerves V and VII", "correct": true}, {"label": "D", "text": "Cranial nerves IX and X", "correct": false}], "correct_answer": "C. Cranial nerves V and VII", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sKXs4RoXBwX8bUp9Ehk01745420415.mp3", "video": ""}, {"text": "Which of the following statements is true regarding transverse fractures of the temporal bone?", "options": [{"label": "A", "text": "They are more common than longitudinal fractures.", "correct": false}, {"label": "B", "text": "Bleeding from the ear is common due to injury to the tegmen and tympanic membrane.", "correct": false}, {"label": "C", "text": "They commonly result in sensorineural hearing loss.", "correct": true}, {"label": "D", "text": "Facial paralysis occurs less frequently and usually has a delayed onset.", "correct": false}], "correct_answer": "C. They commonly result in sensorineural hearing loss.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0QZVsVuihvsd5MDtpHHw1738728243.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Longitudinal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transverse</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common (80%)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common (20%) (Option A)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parietal blow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occipital blow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the long <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> of the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> which starts at the <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> part of the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs across the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> which starts at the <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> magnum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bleeding from ear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common, due to injury to <span class=\"customMeta\" data-dictid=\"6705302d2c1692777200d7164dd10a\">tegmen</span> and TM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent (Option B)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF otorrhoea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures injured</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tegmen, ossicles and TM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Labyrinth, CN VIII</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hearing loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conductive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensorineural (Option C)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertigo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less often</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Facial paralysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less, delayed onset.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common, immediate onset. (Option D)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SViaMkZ9FQ9K2VtViqWY1745420173.mp3", "video": ""}, {"text": "A 60-year-old man presents with a painful vesicular rash on his right ear, along with weakness on the same side of his face, making it difficult to close his eye. He also reports hearing loss and vertigo. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bell's Palsy", "correct": false}, {"label": "B", "text": "Melkersson-Rosenthal Syndrome", "correct": false}, {"label": "C", "text": "Ramsay Hunt Syndrome", "correct": true}, {"label": "D", "text": "Acoustic Neuroma", "correct": false}], "correct_answer": "C. Ramsay Hunt Syndrome", "question_images": ["https://image.prepladder.com/content/IIIBaTHDVbHfyZVizMfo1738727268.png"], "explanation_images": ["https://image.prepladder.com/content/6AL34FWXtcn1f4i31V461738728040.png", "https://image.prepladder.com/content/DtsPgbsy9NZEOq25MMg41738728103.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/jE9gflPKcBjtFduGzTx01745419592.mp3", "video": ""}, {"text": "A 58-year-old woman presents with weakness in the lower right side of her face. She notes that she can still raise her eyebrows and wrinkle her forehead on both sides. Her emotional expressions seem normal. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Lower motor neuron facial nerve palsy", "correct": false}, {"label": "B", "text": "Supranuclear facial nerve palsy", "correct": true}, {"label": "C", "text": "Bell's palsy", "correct": false}, {"label": "D", "text": "Trigeminal nerve palsy", "correct": false}], "correct_answer": "B. Supranuclear facial nerve palsy", "question_images": ["https://image.prepladder.com/content/yF5ZFMK4ETk55IGyvPMX1738726212.png"], "explanation_images": ["https://image.prepladder.com/content/mSKcXNHEnMaSShO3VW4q1738726263.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0EksfWqbteZjmDf2643v1745414594.mp3", "video": ""}, {"text": "A 45-year-old diabetic male presents to your clinic as shown Choose the inappropriate statement regarding the likely diagnosis.", "options": [{"label": "A", "text": "Males and females are equally affected", "correct": false}, {"label": "B", "text": "LMN type of paralysis", "correct": false}, {"label": "C", "text": "Most commonly vertical segment is affected", "correct": true}, {"label": "D", "text": "Majority of cases recover completely", "correct": false}], "correct_answer": "C. Most commonly vertical segment is affected", "question_images": ["https://image.prepladder.com/notes/EClVvAhN1kVc45IJYgWI1746266035.png"], "explanation_images": ["https://image.prepladder.com/notes/EClVvAhN1kVc45IJYgWI1746266035.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common cause of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy</li>\n<li>Characterized by idiopathic, <strong>LMN <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis</strong> of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> onset <strong>(Option B)</strong></li>\n<li><strong>Most commonly the <span class=\"customMeta\" data-dictid=\"4c41e52057169277719199abf55761\">Labyrinthine</span> segment</strong> of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve is involved. <strong>(Option C)</strong></li>\n<li><strong>Males and females are equally affected. </strong><strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic: Most common cause</strong></li>\n<li>Viral Infection: <strong>HSV</strong> &gt;&gt; <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">Herpes</span> zoster</li>\n<li>Vascular Ischemia</li>\n<li>Hereditary: Positive family history in 6-8%</li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More common in diabetics (due to angiopathy) and pregnant women (due to fluid retention).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden onset of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> with inability to close the eye (Bell's phenomenon), <span class=\"customMeta\" data-dictid=\"0bead1317716927771827dc3e80706\">asymmetry</span> of the face, epiphora, drooping mouth, and dribbling of saliva.</li>\n<li>Associated symptoms may include ear pain, noise <span class=\"customMeta\" data-dictid=\"7794e5fd7a1692777190ee626ede62\">intolerance</span> (stapedial paralysis), or loss of taste (chorda tympani involvement).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is made by excluding other causes of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General: Reassurance, pain relief, eye protection and physiotherapy</li>\n<li>Medical: <strong>Prednisolone</strong> 60 mg per day for 5 days then <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> by 10 mg per day (for a total treatment time of 10 days) and 50 mg per day (in two divided doses) for 10 days, <strong>Acyclovir</strong></li>\n<li>Surgical: Nerve decompression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>85%-90% of patients fully recover </strong><strong>(Option D)</strong></li>\n<li>Incomplete resolution are mainly seen in recurrent/late recovery cases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GsiVXCxTJodAZ1Xmex7p1745418908.mp3", "video": ""}, {"text": "Choose the correct set of facial nerve branch involved and interpretation of a positive test with respect to the image shown below", "options": [{"label": "A", "text": "Greater petrosal nerve: &amp;gt;25% unilateral decrease in lacrimation", "correct": false}, {"label": "B", "text": "Greater petrosal nerve: &amp;gt;75% unilateral decrease in lacrimation", "correct": true}, {"label": "C", "text": "Lesser petrosal nerve: &amp;gt;25% unilateral decrease in lacrimation", "correct": false}, {"label": "D", "text": "Lesser petrosal nerve: &amp;gt;75% unilateral decrease in lacrimation", "correct": false}], "correct_answer": "B. Greater petrosal nerve: &gt;75% unilateral decrease in lacrimation", "question_images": ["https://image.prepladder.com/content/q7Lh9coeuiY4Pxg3AfqS1738726647.png"], "explanation_images": ["https://image.prepladder.com/content/e4konMqD8HyVTxB7Cj8l1738726700.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve Branch </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Assessment/Outcome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schirmer’s Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Greater (superficial) <span class=\"customMeta\" data-dictid=\"e3c6e8362e1692777195a07373caf0\">petrosal</span> nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <strong>decrease in tear production</strong> (<strong>&gt;75%</strong>) <strong>(Option B)</strong><strong> </strong>or</li>\n<li>Bilateral reduction (less than 10 mm in both eyes after 5 minutes).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedial Reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nerve to <span class=\"customMeta\" data-dictid=\"392f0cadaf1692777199b8172a5962\">stapedius</span> muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reflex is either present or absent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electro- gustometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chorda tympani</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The taste threshold is compared between the two sides to detect abnormalities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salivary Flow Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chorda tympani</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A 25% reduction in salivary flow is considered abnormal</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electroneuronography (ENoG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Done between 3 days - 3 weeks</li>\n<li>False positive within &lt;3 days, due to <span class=\"customMeta\" data-dictid=\"54dcaa4c1616927772021796ebe812\">wallerian</span> degeneration</li>\n<li>Not useful in long-standing paralysis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electromyography (EMG)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Done after 2 weeks</li>\n<li>Used for testing in long-standing paralysis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QB8BiO78COeNEdrTk0Hy1745418425.mp3", "video": ""}, {"text": "Nerve that carries taste sensation from the yellow-shaded region of the tongue in the image below arises from?", "options": [{"label": "A", "text": "At the level of 1st genu", "correct": false}, {"label": "B", "text": "At the level of 2nd genu", "correct": false}, {"label": "C", "text": "Middle of the horizontal segment", "correct": false}, {"label": "D", "text": "Middle of the vertical segment", "correct": true}], "correct_answer": "D. Middle of the vertical segment", "question_images": ["https://image.prepladder.com/content/o4QXgCRFNitbrcRWfjYF1738726520.png"], "explanation_images": ["https://image.prepladder.com/content/RBbl8mvjuh8MhLSNLZRS1738726550.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Branch </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Greater <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">Superficial</span> <span class=\"customMeta\" data-dictid=\"e3c6e8362e1692777195a07373caf0\">Petrosal</span> Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Geniculate ganglion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carries <span class=\"customMeta\" data-dictid=\"591ff46f251692777198992363d6f3\">secretomotor</span> fibers to the <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> gland, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and palate.</li>\n<li>Tested by <strong>Schirmer’s test</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve to Stapedius</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At the level of the second genu</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supplies the <span class=\"customMeta\" data-dictid=\"392f0cadaf1692777199b8172a5962\">stapedius</span> muscle.</li>\n<li>Tested by <strong>Stapedial reflex.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chorda Tympani</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle of the vertical segment</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carries <span class=\"customMeta\" data-dictid=\"591ff46f251692777198992363d6f3\">secretomotor</span> fibers to <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> and <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> glands.</li>\n<li>Taste sensation from<strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> two-thirds</strong> of the tongue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">Auricular</span> Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facial nerve trunk</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supplies muscles of the <span class=\"customMeta\" data-dictid=\"7aafd1d2571692777195e9d2250eab\">pinna</span> and <span class=\"customMeta\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\">occipital</span> belly of the occipitofrontalis.</li>\n<li>Communicates with the <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> branch of the vagus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Terminal Branches</strong></p>\n<p>(Temporal, Zygomatic, Buccal, Mandibular, Cervical)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> after crossing <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supplies muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expression.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MLgKu9KJHn1r2Oc6Ibkx1745418202.mp3", "video": ""}, {"text": "Choose the correct set of statements regarding the course of the facial nerve 1) The extracranial part of facial nerve lies lateral to retromandibular vein 2) Facial nerve exits the skull via stylomastoid foramen 3) Greater petrosal nerve is a branch of facial nerve after the formation of geniculate ganglion 4) The facial nerve enters the internal acoustic meatus along with the vestibulocochlear nerve", "options": [{"label": "A", "text": "Only 1", "correct": false}, {"label": "B", "text": "2,3,4", "correct": true}, {"label": "C", "text": "1,2,4", "correct": false}, {"label": "D", "text": "1,2,3,4", "correct": false}], "correct_answer": "B. 2,3,4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0BdFMLOvSSr1S1y0Xzth1738726458.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Entry into <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">Parotid</span> Gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Main trunk enters on the <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">posteromedial</span> surface of the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> gland.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Division of Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Divides within the gland, <strong>behind and <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> to the retromandibular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> </strong><strong>(Statement 1)</strong><strong> </strong>and external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (ECA).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporofacial vs. <span class=\"customMeta\" data-dictid=\"cea57afffa1692777184390211b80c\">Cervicofacial</span> Trunks</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Temporofacial trunk:</strong> Contains <strong>more axons</strong> but fewer fascicles.</li>\n</ul>\n<ul>\n<li><strong>Cervicofacial trunk:</strong> Contains <strong>more fascicles</strong> but fewer axons.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Formation of <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">Parotid</span> Plexus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The trunks branch further to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> (pes anserinus) from which the <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> branches arise.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Terminal Branches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Temporal, zygomatic, buccal, marginal mandibular, and cervical.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lAU30MlTU26WEgDVMrPU1745417978.mp3", "video": ""}, {"text": "A 50-year-old female known hypertensive presented with sudden onset weakness over the left half of her body. On examination, her face was deviated to one side associated with slurring of speech. The doctor asks the intern to perform a facial nerve examination. Which among the following statements is correct regarding the most likely intratemporal segment of the nerve involved?", "options": [{"label": "A", "text": "Contains epineurial and perineurial sheaths", "correct": false}, {"label": "B", "text": "Only segment of the facial nerve that lacks anastomosing cascades", "correct": true}, {"label": "C", "text": "Bill’s bar is related to this segment", "correct": false}, {"label": "D", "text": "Shortest and widest segment of facial nerve", "correct": false}], "correct_answer": "B. Only segment of the facial nerve that lacks anastomosing cascades", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rg45QbKt6vNuZvHBVovm1738726388.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meatal segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>8-10mm length, within IAM</li>\n<li><strong>Bill’s bar</strong> is a bony landmark related to the Meatal segment of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Labyrinthine segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>4mm length, from <span class=\"customMeta\" data-dictid=\"67492c42be16927772039f6e37110e\">fundus</span> of <span class=\"customMeta\" data-dictid=\"6da3f0528c1692777192e9b608d735\">meatus</span> to <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">geniculate</span> ganglion</li>\n<li><strong>Shortest and narrowest </strong>segment <strong>(Option D)</strong></li>\n<li><strong>Most <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> segment to <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> (narrowest) and ischaemia </strong>due to lack of anastomosing arterial cascades.<strong>(Option B)</strong></li>\n<li>Ends at <strong>1st genu.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tympanic (horizontal) segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>11mm length, from <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">geniculate</span> <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> to just above the <span class=\"customMeta\" data-dictid=\"d3b981dbf916927771961c29f24614\">pyramidal</span> eminence.</li>\n<li><strong>Most common site of <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> of <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone (facial canal)</strong></li>\n<li>Lies above <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> window and below <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> semicircular canal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mastoid (vertical) segment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>13mm length,from the <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> to the <span class=\"customMeta\" data-dictid=\"10a9865a511692777199f3007e4f54\">stylomastoid</span> foramen</li>\n<li><strong>Arises from 2nd genu.</strong></li>\n<li>Most common segment to be injured in <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> surgery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve Branch </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Assessment/Outcome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schirmer’s Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Greater (superficial) <span class=\"customMeta\" data-dictid=\"e3c6e8362e1692777195a07373caf0\">petrosal</span> nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <strong>decrease in tear production</strong> (<strong>&gt;75%</strong>) <strong>(Option B)</strong><strong> </strong>or</li>\n<li>Bilateral reduction (less than 10 mm in both eyes after 5 minutes).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedial Reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nerve to <span class=\"customMeta\" data-dictid=\"392f0cadaf1692777199b8172a5962\">stapedius</span> muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reflex is either present or absent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electro- gustometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chorda tympani</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The taste threshold is compared between the two sides to detect abnormalities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salivary Flow Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chorda tympani</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A 25% reduction in salivary flow is considered abnormal</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Choose the correct course of the intracranial part of the facial nerve.", "options": [{"label": "A", "text": "VIIth nerve nucleus→pontomedullary junction→posterior cranial fossa→internal acoustic meatus", "correct": true}, {"label": "B", "text": "Internal acoustic meatus→VIIth nerve nucleus→posterior cranial fossa→pontomedullary junction", "correct": false}, {"label": "C", "text": "Posterior cranial fossa→internal acoustic meatus→pontomedullary junction→VIIth nerve nucleus", "correct": false}, {"label": "D", "text": "Pontomedullary junction→VIIth nerve nucleus→internal acoustic meatus→posterior cranial fossa", "correct": false}], "correct_answer": "A. VIIth nerve nucleus→pontomedullary junction→posterior cranial fossa→internal acoustic meatus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QoTrM0ESQghZhEl51owU1738726332.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OXt2ZPybZCqy5aKI9aHb1745415153.mp3", "video": ""}, {"text": "A 55-year-old patient experiences sudden right-sided facial drooping and weakness in the left arm and leg following a stroke. The stroke is in the ventral part of the pons (basis pontis). Infranuclear fascicular fibers of cranial nerve VII (CN VII) ipsilaterally and the corticospinal tract contralaterally are affected. What is the diagnosis?", "options": [{"label": "A", "text": "Foville Syndrome", "correct": false}, {"label": "B", "text": "Wallenberg Syndrome", "correct": false}, {"label": "C", "text": "Millard-Gubler Syndrome", "correct": true}, {"label": "D", "text": "Weber Syndrome", "correct": false}], "correct_answer": "C. Millard-Gubler Syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KrH7QxtvkJ2rfTl0nUEJ1745414965.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 27 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 8 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 9 month old baby was brought by the parents as she doesn't respond to their calls and was evaluated and found to have hearing loss. Which of the following would be a contraindication for cochlear implant in this case?", "options": [{"label": "A", "text": "Bilateral profound sensorineural hearing loss", "correct": false}, {"label": "B", "text": "Cochlear aplasia", "correct": true}, {"label": "C", "text": "Prelingual deafness", "correct": false}, {"label": "D", "text": "Age older than 6 months", "correct": false}], "correct_answer": "B. Cochlear aplasia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8nwDVUlNkE0rWUwnAB8w1745003524.mp3", "video": ""}, {"text": "In a cochlear implant, what is the primary role of the external speech processor?", "options": [{"label": "A", "text": "To amplify sound before it reaches the brain", "correct": false}, {"label": "B", "text": "To convert captured sound into digital signals", "correct": true}, {"label": "C", "text": "To stimulate the auditory nerve directly", "correct": false}, {"label": "D", "text": "To provide power to the internal components", "correct": false}], "correct_answer": "B. To convert captured sound into digital signals", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ITxIYTKIYNqTYXWAh0yl1739297578.png", "https://image.prepladder.com/content/MHCXapf304TqlD9AiXiU1739297621.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mV6rF8adCMHoiRycAPs41745003891.mp3", "video": ""}, {"text": "Where is the electrode array placed during cochlear implant surgery to ensure effective stimulation of the auditory nerves?", "options": [{"label": "A", "text": "Round window membrane", "correct": false}, {"label": "B", "text": "Scala tympani", "correct": true}, {"label": "C", "text": "Eustachian tube", "correct": false}, {"label": "D", "text": "Outer ear canal", "correct": false}], "correct_answer": "B. Scala tympani", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:429px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Facial paralysis</li>\n<li>Wound infection</li>\n<li>Wound dehiscence</li>\n<li>Flap necrosis</li>\n<li>Electrode migration</li>\n<li>Device failure</li>\n<li>CSF leak</li>\n<li>Meningitis</li>\n<li>Post-operative dizziness/vertigo</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Exposure of device and extrusion</li>\n<li>Pain at the site of implant</li>\n<li>Migration and <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of device</li>\n<li>Late device failure</li>\n<li>Otitis media</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9ojy3vTpaG4bEFKYcTDx1745003944.mp3", "video": ""}, {"text": "A 10-year-old child with microtia and chronic ear discharge is being evaluated for hearing rehabilitation. Which of the following is the most appropriate hearing device for this child?", "options": [{"label": "A", "text": "Traditional behind-the-ear hearing aid", "correct": false}, {"label": "B", "text": "Air-conduction hearing aid", "correct": false}, {"label": "C", "text": "Bone-Anchored Hearing Aid (BAHA)", "correct": true}, {"label": "D", "text": "CROS hearing aid", "correct": false}], "correct_answer": "C. Bone-Anchored Hearing Aid (BAHA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1gBY7nqtfEoemdibDDS41739297726.png", "https://image.prepladder.com/content/c7j3IOwoCGucn8RnniH11739297746.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lYe3eqLcUT1sJZEArQJM1745004106.mp3", "video": ""}, {"text": "A 45-year-old patient with neurofibromatosis type 2 has undergone bilateral vestibular schwannoma resection and now experiences profound hearing loss. Which implant would be most suitable for this patient to restore some auditory function?", "options": [{"label": "A", "text": "Cochlear Implant", "correct": false}, {"label": "B", "text": "Auditory Brainstem Implant (ABI)", "correct": true}, {"label": "C", "text": "Bone-Anchored Hearing Aid", "correct": false}, {"label": "D", "text": "Middle Ear Implant", "correct": false}], "correct_answer": "B. Auditory Brainstem Implant (ABI)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FDJqZoHNEW6nolKK9tF31739297882.png", "https://image.prepladder.com/content/jZG06Yz0w9C8UrZBQkWV1739297912.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JSlZVsn1dvdyDQsegIgr1745170160.mp3", "video": ""}, {"text": "A 45-year-old patient with high-frequency sensorineural hearing loss is recommended for an In-the-Canal (ITC) hearing aid. What is a key characteristic of this type of hearing aid?", "options": [{"label": "A", "text": "It is worn entirely behind the ear.", "correct": false}, {"label": "B", "text": "It is visible and large.", "correct": false}, {"label": "C", "text": "It fits partially in the ear canal, making it less noticeable.", "correct": true}, {"label": "D", "text": "It provides amplification for all frequency ranges equally", "correct": false}], "correct_answer": "C. It fits partially in the ear canal, making it less noticeable.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XyTwb59H4ETPncCsGkDR1739297987.png", "https://image.prepladder.com/content/301VdrRZ5x3wUulrmQXu1739298583.png", "https://image.prepladder.com/content/UOGJjDpCvoptBr5aNCv31739298119.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7lA9Uyfqib4cD700ANPs1745171480.mp3", "video": ""}, {"text": "A 35-year-old male presents with a dental cavity that has been causing significant discomfort for the past few days. He now reports a new onset of ear pain on the same side as the toothache. Which of the following nerves is most likely involved in transmitting the pain from the dental cavity to the ear?", "options": [{"label": "A", "text": "Auriculotemporal nerve", "correct": true}, {"label": "B", "text": "Glossopharyngeal nerve", "correct": false}, {"label": "C", "text": "Arnold's nerve", "correct": false}, {"label": "D", "text": "Maxillary nerve (V2)", "correct": false}], "correct_answer": "A. Auriculotemporal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/T9RJ0BwZZVy7WHGB2YKT1739343968.png", "https://image.prepladder.com/content/dJLtbZoYJRZ8iBXQciCJ1739298316.png", "https://image.prepladder.com/content/y2kP8J5V8sQE5hKfEgXT1739298331.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nerve Supply of the Ear</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pinna (External Ear)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>G</strong>reater <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve (C2, C3)</li>\n<li>Lesser <strong>O</strong>ccipital nerve (C2, C3)</li>\n<li><strong>A</strong>uriculotemporal nerve (Branch of <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">Trigeminal</span> nerve - V3)</li>\n<li><strong>A</strong>rnold's nerve (Auricular branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">Vagus</span> nerve - X)</li>\n<li><strong>F</strong>acial nerve (VII)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>External <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">Auditory</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> (EAC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A</strong>uriculotemporal nerve (Trigeminal nerve - V3)</li>\n<li><strong>A</strong>rnold's nerve (Vagus nerve - X)</li>\n<li><strong>F</strong>acial nerve (VII)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tympanic membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A</strong>uriculotemporal nerve (Trigeminal nerve - V3)</li>\n<li><strong>A</strong>rnold's nerve (Auricular branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">Vagus</span> nerve - X)</li>\n<li><strong>J</strong>acobson's nerve (Tympanic branch of the <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> nerve)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lesion Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathway for <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">Referred</span> Otalgia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oropharynx, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> 1/3 of tongue, Tonsils, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> Pharyngeal Wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glossopharyngeal nerve (IX)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Jacobson's nerve mediates pain from pharyngeal structures to the ear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larynx, Hypopharynx, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> Esophagus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vagus nerve (X)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arnold's nerve transmits pain from the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> and <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> to the ear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervical Spine (Cervical Spondylosis, C2-C3)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lesser <span class=\"customMeta\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\">occipital</span> nerve, Greater <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve (C2, C3)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These nerves can cause ear pain in <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine conditions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temporo-mandibular Joint (TMJ)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trigeminal nerve (V3), <span class=\"customMeta\" data-dictid=\"c2c10e783c1692777182a1d84457f9\">Auriculotemporal</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain from the <span class=\"customMeta\" data-dictid=\"0809704acb169277720067fa3e8981\">TMJ</span> can be <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to the ear via the <span class=\"customMeta\" data-dictid=\"c2c10e783c1692777182a1d84457f9\">auriculotemporal</span> nerve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Teeth, Parotid, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> 2/3 of tongue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trigeminal nerve (V3)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dental pain, <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> pathologies, and tongue lesions may cause ear pain via the <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nose and Sinuses</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trigeminal nerve (V2, V3)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sinus infections and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> issues may refer pain to the ear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oesophagus, Hypopharynx, Larynx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vagus nerve (X)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conditions like <span class=\"customMeta\" data-dictid=\"01e03927231692777188168edc7b35\">GERD</span> or laryngeal cancer can cause <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> ear pain.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iGbRb8L4ihHd7jF9ehN41745172331.mp3", "video": ""}, {"text": "A 50-year-old male presents to the ENT clinic with complaints of a persistent ringing sound in his left ear for the past few months, more noticeable at night when he is in quiet environments. He denies any hearing loss or ear discharge. Otoscopic examination is normal, and audiometry shows normal hearing. Which of the following is the most appropriate initial management?", "options": [{"label": "A", "text": "Prescribe an antidepressant", "correct": false}, {"label": "B", "text": "Perform an MRI to rule out acoustic neuroma", "correct": false}, {"label": "C", "text": "Reassure the patient and consider tinnitus retraining therapy", "correct": true}, {"label": "D", "text": "Advise complete avoidance of noise exposure", "correct": false}], "correct_answer": "C. Reassure the patient and consider tinnitus retraining therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:703px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subjective Tinnitus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Objective Tinnitus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ringing sensation is only experienced by the patient and cannot be detected or measured by an examiner.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tinnitus is associated with an identifiable organic cause that can be detected by both the patient and the examiner.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Otologic:</strong></p>\n<ul>\n<li>Tympanic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> perforation</li>\n<li>Ear <span class=\"customMeta\" data-dictid=\"9eae373ada1692777202074bbc0222\">wax</span> accumulation</li>\n<li>Fluid in the middle ear</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media</li>\n<li>Ménière's disease</li>\n<li>Presbycusis (age-related hearing loss)</li>\n<li>Noise-induced hearing loss</li>\n<li>Acoustic neuroma</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Metabolic:</strong></p>\n<ul>\n<li>Hyperthyroidism</li>\n<li>Hyperdynamic circulation</li>\n<li>Obesity</li>\n<li>Hyperlipidemia</li>\n<li>Vitamin <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (e.g., B12)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Neurologic:</strong></p>\n<ul>\n<li>Brain stroke</li>\n<li>Brain infarction</li>\n<li>Head trauma</li>\n<li>Fractures</li>\n<li>Multiple sclerosis</li>\n<li>Postmeningitic hearing loss</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Cardiovascular:</strong></p>\n<ul>\n<li>Anemia</li>\n<li>Hypertension</li>\n<li>Hypotension</li>\n<li>Atherosclerosis</li>\n<li>Hyperdynamic circulation</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Pharmacologic</strong>:</p>\n<ul>\n<li>Ototoxic drugs (e.g., certain antibiotics, diuretics)</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Psychogenic:</strong></p>\n<ul>\n<li>Tinnitus without identifiable physical findings; often associated with Anxiety, depression, stress</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vascular (</strong>synchronized with pulse - <strong>Pulsatile tinnitus):</strong></p>\n<ul>\n<li>AV fistula</li>\n<li>Dehiscence of the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery</li>\n<li>Glomus tumor of middle ear</li>\n<li>Jugular bulb abnormalities</li>\n<li>Carotid aneurysm</li>\n<li>Carotid stenosis</li>\n<li>Vascular loop pressing on <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve VIII</li>\n<li>High-riding <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery</li>\n<li>Persistent stapedial artery</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Patulous <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> Tube: </strong>Tinnitus synchronized with respiration</p>\n\t\t\t \n\n\t\t\t<p><strong>Other causes:</strong></p>\n<ul>\n<li>Palatal myoclonus</li>\n<li>TMJ disorders</li>\n<li>Idiopathic stapedial myoclonus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subjective Tinnitus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Objective Tinnitus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perceived only by the patient</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Perceived by both the patient and examiner</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot be objectively measured</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be detected through physical examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Otologic, metabolic, neurologic, cardiovascular, pharmacologic, psychogenic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vascular, <span class=\"customMeta\" data-dictid=\"96a79f90a716927771940f69fcade2\">patulous</span> <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Retraining Therapy, Counseling, CBT, Sound therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment of the underlying cause (Surgical or interventional procedures)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WknuXuRhH9aBEsHQbk3p1745172610.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 18 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
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Episodic vertigo with fluctuating hearing loss and tinnitus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertigo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Episodic with sudden onset</strong></li>\n<li>Attacks occur in clusters, interspersed with periods of <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> accompanied by nausea, vomiting, <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> &amp; nystagmus.</li>\n<li>Loud noises might trigger <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> due to the<strong> Tullio phenomenon.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fluctuating</strong> <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> may improve between attacks but may progressively worsen over time, with some degree of permanent hearing loss.</li>\n<li>Sensorineural <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> initially affecting<strong> lower frequencies</strong>.</li>\n<li>Patients might experience distorted hearing or<strong> Diplacusis</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tinnitus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Low-pitched &amp; <span class=\"customMeta\" data-dictid=\"2499b2018a16927771978059423918\">Roaring</span> type</strong></li>\n<li>It can be aggravated during <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks and might persist during periods of remission</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aural Fullness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluctuates</strong> &amp; may vary in intensity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emotional Impact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> nature of symptoms can lead to emotional stress and <span class=\"customMeta\" data-dictid=\"c31ab816e01692777181649c694d46\">apprehension</span> about future attacks, contributing to overall distress.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZnVrSYflUYNg4rhxrI251745172830.mp3", "video": ""}, {"text": "A 45-year-old male patient presents with episodes of vertigo, fluctuating hearing loss, tinnitus, and aural fullness. Which of the following mechanisms is associated with the pathogenesis of this condition?", "options": [{"label": "A", "text": "Excessive production of perilymph fluid", "correct": false}, {"label": "B", "text": "Defective absorption of endolymph", "correct": true}, {"label": "C", "text": "Dilatation of the internal auditory artery", "correct": false}, {"label": "D", "text": "Vestibular nerve degeneration", "correct": false}], "correct_answer": "B. Defective absorption of endolymph", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jPYVBbklVhcag08sliNu1738820513.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PEbSG9V0ghsVDeSM01lx1745173002.mp3", "video": ""}, {"text": "A 45-year-old male presents with recurrent vertigo, tinnitus, and a sensation of fullness in his left ear, along with progressive hearing loss. He is diagnosed with Meniere’s disease, and audiometric testing is performed. Which part of the cochlea and what frequency range is typically affected first?", "options": [{"label": "A", "text": "Apical turn of the cochlea is affected causing high-frequency hearing loss", "correct": false}, {"label": "B", "text": "Basal turn of the cochlea is affected causing low-frequency hearing loss", "correct": false}, {"label": "C", "text": "Apical turn of the cochlea is affected causing low-frequency hearing loss", "correct": true}, {"label": "D", "text": "Basal turn of the cochlea is affected causing high-frequency hearing loss", "correct": false}], "correct_answer": "C. Apical turn of the cochlea is affected causing low-frequency hearing loss", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lGXTLpz91p3wzGMKmFrR1738820573.png", "https://image.prepladder.com/content/Ucitsh3KbMsZY06OAmwS1738820596.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/J8XlZXlzfnjiSkTwcaAM1745173372.mp3", "video": ""}, {"text": "A 52-year-old patient is evaluated for symptoms of recurrent vertigo, fluctuating hearing loss, and a feeling of fullness in the ear. After a comprehensive assessment, which diagnostic test is most definitive for confirming Meniere’s disease?", "options": [{"label": "A", "text": "Pure Tone Audiometry", "correct": false}, {"label": "B", "text": "Speech Audiometry", "correct": false}, {"label": "C", "text": "Electrocochleography", "correct": true}, {"label": "D", "text": "Glycerol Test", "correct": false}], "correct_answer": "C. Electrocochleography", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations of Meniere’s Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pure Tone Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Measures hearing sensitivity across various frequencies.</li>\n<li>Sensorineural <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> affects <strong>lower frequencies</strong>, resulting in a <strong>rising </strong>audiogram curve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Speech Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assesses the ability to understand and discriminate speech.</li>\n<li>Scores typically range from 55%-85% between attacks but worsen significantly during and immediately after an attack, with normal scores (90%-100%) in unaffected periods.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Special <span class=\"customMeta\" data-dictid=\"bea72ef8a31692777182f3d4e551c6\">Audiometric</span> Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Help <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> Cochlear from <span class=\"customMeta\" data-dictid=\"1c45b1dca81692777197ac9ff22f0e\">Retrocochlear</span> lesions</li>\n<li><strong>Recruitment Test</strong>: Positive in Meniere’s disease, indicating increased sensitivity to sound.</li>\n<li><strong>Short <span class=\"customMeta\" data-dictid=\"a9838acc3316927771903ae9e67514\">Increment</span> Sensitivity Index (SISI) Test</strong>: Scores greater than 70% in about two-thirds of Meniere’s patients (normal score is 15%).</li>\n<li><strong>Tone <span class=\"customMeta\" data-dictid=\"6a867651ba1692777185bb15ba2f9c\">Decay</span> Test</strong>: Normally shows less than 20 dB decay, indicating a cochlear issue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrocochleography</strong></p>\n<p><strong>(Diagnostic)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Measures the electrical potentials from the <span class=\"customMeta\" data-dictid=\"a1b8deb0fe1692777190df5ce46525\">inner ear</span> in response to sound.</li>\n<li>In normal ears, the summating potential (SP) to <span class=\"customMeta\" data-dictid=\"1313ac90ca16927771807502911c57\">action potential</span> (AP) ratio is around 30%, while in Meniere’s disease, it is <strong>&gt;30%.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caloric Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assesses the function of the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> system by irrigating the ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> with warm or cold water.</li>\n<li>Typically, it shows <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> response on the affected side in about 75% of cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glycerol Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Evaluates the effect of <span class=\"customMeta\" data-dictid=\"124462cc291692777188e1a9cce583\">glycerol</span> in reducing endolymphatic pressure.</li>\n<li>A positive result is indicated by:\n\t\t\t\t<ul>\n<li>10 dB improvement in two or more adjacent octaves</li>\n<li>10% increase in <span class=\"customMeta\" data-dictid=\"887c38263b16927771987e127c78dd\">speech discrimination</span> score.</li>\n<li>Improvement in <span class=\"customMeta\" data-dictid=\"1e668dc8ba1692777200622a8a97f3\">tinnitus</span> and ear fullness.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/msI9fNWdZR4X4H7RO24G1745173693.mp3", "video": ""}, {"text": "In MRI with gadolinium contrast for Meniere’s disease, which of the following findings is typical?", "options": [{"label": "A", "text": "Gadolinium in scala vestibuli &amp;amp; absent in scala tympani", "correct": false}, {"label": "B", "text": "Gadolinium is present in all three compartments", "correct": true}, {"label": "C", "text": "Gadolinium in scala media only", "correct": false}, {"label": "D", "text": "Gadolinium in the cochlear duct only", "correct": false}], "correct_answer": "B. Gadolinium is present in all three compartments", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4JC27xKKB76JftpZBt1b1745174100.mp3", "video": ""}, {"text": "A 45-year-old man presents with vertigo triggered by loud noises. His medical history includes a surgical fenestration for a middle ear condition. Audiometric tests are within normal limits, but vestibular testing reveals abnormal pressure responses. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hennebert’s Sign", "correct": false}, {"label": "B", "text": "Tullio Phenomenon", "correct": true}, {"label": "C", "text": "Lhermitte’s Sign", "correct": false}, {"label": "D", "text": "Meniere’s Disease", "correct": false}], "correct_answer": "B. Tullio Phenomenon", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tRoRBqs8TtLooGToUOij1745174495.mp3", "video": ""}, {"text": "A 50-year-old patient presents with recurrent episodes of vertigo lasting several hours, associated with fluctuating hearing loss, tinnitus, and aural fullness in one ear. The symptoms have progressively worsened, and episodes are unpredictable. What is the first line of management for this condition?", "options": [{"label": "A", "text": "Intratympanic gentamicin", "correct": false}, {"label": "B", "text": "Low-salt diet and diuretics", "correct": true}, {"label": "C", "text": "Vestibular rehabilitation therapy", "correct": false}, {"label": "D", "text": "Endolymphatic sac surgery", "correct": false}], "correct_answer": "B. Low-salt diet and diuretics", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:650px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of Meniere's disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Category</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle Modifications</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low-salt diet</li>\n<li>Caffeine, alcohol, <span class=\"customMeta\" data-dictid=\"ab7b0c22011692777193361d22130c\">nicotine</span> avoidance</li>\n<li>Stress management (yoga, <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> exercises)</li>\n<li>Hydration</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medications</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diuretics</strong> (e.g., furosemide, hydrochlorothiazide): Decreases fluid buildup in the inner ear</li>\n<li><strong>Vestibular sedatives </strong>(e.g., prochlorperazine): Controls symptoms of <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> and <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> during <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks.</li>\n<li><strong>Betahistine</strong> (Vertin): Acts as a <span class=\"customMeta\" data-dictid=\"8827b8fae316927772019c9b7b884f\">vasodilator</span> to improve <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the inner ear, potentially reducing vertigo.</li>\n<li><strong>Antihistamines</strong> (e.g., Meclizine): Provides <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief for vertigo.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intratympanic Injections</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Gentamicin:</strong> Used in <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases to destroy <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> hair cells and reduce vertigo.</li>\n<li><strong>Corticosteroids:</strong> Reduces <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> in the inner ear, potentially alleviating symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Options</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Endolymphatic <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> decompression:</strong> Decreases fluid pressure within the endolymphatic system</li>\n<li><strong>Vestibular nerve section: </strong>Severing the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nerve to relieve <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> while preserving hearing (in severe cases).</li>\n<li><strong>Labyrinthectomy</strong>: Complete destruction of the balance organs (last resort, leads to complete hearing loss).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wIfElOrtUnlRqcK27qS61745174724.mp3", "video": ""}, {"text": "A 45-year-old woman with Ménière's disease has severe, recurrent vertigo despite conservative treatments. Her ENT specialist recommends a surgical procedure to reduce vertigo attacks while aiming to preserve her hearing. Which surgical procedure is most appropriate for her condition?", "options": [{"label": "A", "text": "Endolymphatic sac decompression", "correct": true}, {"label": "B", "text": "Vestibular nerve section", "correct": false}, {"label": "C", "text": "Labyrinthectomy", "correct": false}, {"label": "D", "text": "Meniett device therapy", "correct": false}], "correct_answer": "A. Endolymphatic sac decompression", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>S</strong><strong>urgical management of Meniere's disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decompression of the Endolymphatic Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces pressure in the endolymphatic system by decompressing the sac.</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Controls <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> while preserving hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endolymphatic <span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\">Shunt</span> Operation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A tube is placed to connect the <span class=\"customMeta\" data-dictid=\"9840f5d4e2169277718767b259be57\">endolymphatic sac</span> with the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space to drain <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> endolymph.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sacculotomy (Fick's Operation)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A needle is used to <span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\">puncture</span> the <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> through the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> to decompress it.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cody's Tack Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A stainless steel tack is placed through the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> to allow <span class=\"customMeta\" data-dictid=\"53ddc0755c1692777195e8d5f9fc68\">periodic</span> <span class=\"customMeta\" data-dictid=\"46a5e63f281692777185d3f56ea186\">decompression</span> of the saccule.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Selective Section of the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> Nerve</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nerve is cut while preserving the cochlear nerve to control vertigo.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally, it preserves hearing but <strong>possesses the risk of hearing loss</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Labyrinthectomy</strong><br/>\n<strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the affected <span class=\"customMeta\" data-dictid=\"7732c8e49d169277719171da17de32\">labyrinth</span> leads to complete <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> on that side but effective control of vertigo.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Controls <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> while hearing is significantly impaired.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZfQM6C4Aj8PxZfUg3znQ1745174969.mp3", "video": ""}, {"text": "A 52-year-old patient presents with recurrent episodes of vertigo but has no reported hearing loss, tinnitus, or aural fullness. Diagnostic tests reveal no abnormalities in the cochlea or hearing function. What is the most likely diagnosis among the variants of Meniere’s disease?", "options": [{"label": "A", "text": "Cochlear Hydrops", "correct": false}, {"label": "B", "text": "Vestibular Hydrops", "correct": true}, {"label": "C", "text": "Tumarkin’s Otolithic Crisis", "correct": false}, {"label": "D", "text": "Lermoyez Syndrome", "correct": false}], "correct_answer": "B. Vestibular Hydrops", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variants of Meniere’s disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Variant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cochlear Hydrops</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms primarily involve the cochlea: fluctuating hearing loss, tinnitus, and fullness, but no vertigo.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased fluid pressure confined to the cochlea, often due to a <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> at the <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> reuniens.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vestibular Hydrops</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presents with episodic <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> while cochlear function remains normal (no hearing loss, tinnitus, or fullness).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluid pressure affects the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> structures, particularly the <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> and utricle, sparing cochlear function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumarkin’s Otolithic Crisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden<strong>\"drop attacks\"</strong> without loss of consciousness and no <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> or hearing loss</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deformation of <span class=\"customMeta\" data-dictid=\"9964c22ac2169277719410824f55e6\">otolith</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> of the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> or <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> due to change in endolymphatic pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lermoyez Syndrome</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms of Meniere’s are seen in reverse order—progressive <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> followed by vertigo.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vpqNbyC9UCSLBGqf4GbO1745217080.mp3", "video": ""}, {"text": "A 55-year-old patient presents with pulsatile tinnitus, hearing loss, a reddish mass behind the tympanic membrane, difficulty swallowing, and hoarseness. Examination reveals glossopharyngeal nerve involvement. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Glomus Tympanicum", "correct": false}, {"label": "B", "text": "Glomus Jugulare", "correct": true}, {"label": "C", "text": "Glomus Vagale", "correct": false}, {"label": "D", "text": "Glomus Caroticum", "correct": false}], "correct_answer": "B. Glomus Jugulare", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IpLP61geok4ZKCuwd8wl1738820734.png", "https://image.prepladder.com/content/cbF7N8XsFT7FquyyG2xz1738820694.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Glomus Tympanicum</strong><br/>\n<strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Glomus Jugulare</strong><br/>\n<strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours arise from the<strong> <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> of the middle ear. </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours originate from the <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of the <strong>jugular bulb </strong>and can extend into the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and surrounding structures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulsatile tinnitus, hearing loss, and a reddish mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulsatile tinnitus, hearing loss, and may involve multiple <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves (IX, X, XI)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Otoscopy findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reddish, <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</li>\n<li>This may lead to <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> and a feeling of fullness in the ear.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Masafumi Ohki, Shigeru Kikuchi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-A-red-mass-was-observed-under-the-anterior-quadrant-of-the-tympanic-membrane-b_fig1_334371255\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/IpLP61geok4ZKCuwd8wl1738820734.png\" width=\"500\"/></p>\n<p><strong>Fig: Glomus Tympanicum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reddish mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, often pulsatile.</li>\n<li>It is associated with neurological symptoms due to <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve involvement, including <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> nerve involvement.</li>\n</ul>\n<p><br/>\n<img alt=\"\" data-author=\"Michael Hawke MD\" data-hash=\"\" data-license=\"CC-BY-4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Glomus_Jugulare_Tumor.jpg\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/cbF7N8XsFT7FquyyG2xz1738820694.png\" width=\"500\"/></p>\n<p><strong>Fig: Glomus Jugular</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xwXHLetJHTWCKnKj8gMn1745217399.mp3", "video": ""}, {"text": "A 42-year-old female presents with progressive conductive hearing loss in her left ear over the past year, accompanied by a sensation of fullness, occasional tinnitus, and a recently discovered pulsating mass behind the left tympanic membrane. What is the investigation of choice for diagnosing this condition?", "options": [{"label": "A", "text": "Contrast-enhanced CT scan", "correct": true}, {"label": "B", "text": "MRI", "correct": false}, {"label": "C", "text": "Biopsy", "correct": false}, {"label": "D", "text": "Angiography", "correct": false}], "correct_answer": "A. Contrast-enhanced CT scan", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ojJ7ipkPNSfz7NdBCAoo1738820800.png", "https://image.prepladder.com/content/3yiopYD84ZrTscvG1ZmV1738820837.png", "https://image.prepladder.com/content/352S51Zmo3isGigC9SI81738820891.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations of <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">Glomus</span> Tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CT scan</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CECT (contrast-enhanced computed tomography) </strong>is the <strong>investigation of choice to distinguish</strong> between <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tympanicum and <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> jugulare tumours and to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> them from an <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, a high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb, or a dehiscent <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb.</li>\n<li><strong>Phelps sign: </strong>On the normal side, the carotico-jugular spine (a dense bone structure between the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> and mastoid) is intact. On the affected side, <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the carotico-jugular spine is observed.</li>\n</ul>\n<img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"509\" src=\"https://image.prepladder.com/content/ojJ7ipkPNSfz7NdBCAoo1738820800.png\" width=\"500\"/>\n<p><strong>CT shows <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the left <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> with bone <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> (arrow)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MRI scan </strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It demonstrates the extent of the tumour within the soft tissue.</li>\n<li><strong>Salt and pepper sign: </strong>Microhemorrhages within the tumour are visualized as white and gray dots on MRI, resulting in a <strong>\"salt-and-pepper\" appearance.</strong></li>\n</ul>\n<img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/3yiopYD84ZrTscvG1ZmV1738820837.png\" width=\"500\"/>\n<p><strong>MRI shows a well-defned mass (arrow) in the left <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen. The mass shows a \"salt and pepper appearance,</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Angiography</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is essential when CT indicates involvement of the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb, <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, or <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> extension. It also aids in identifying additional <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumors, locating <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels, and guiding embolization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Brain <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> and Flow Studies </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These are essential if the tumor compresses the internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n<li>They assess brain perfusion, <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> function, and may involve <span class=\"customMeta\" data-dictid=\"e3827ede5c1692777202c45715fc8e\">xenon</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and <span class=\"customMeta\" data-dictid=\"7cb1c220051692777190be13e8c7cc\">isotope</span> studies to <span class=\"customMeta\" data-dictid=\"7991fb415f16927771887b76483a71\">gauge</span> stroke risk and the need for <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> replacement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Biopsy</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histopathological studies show the<strong> Zell Ballen pattern,</strong> where <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> chief cells and <span class=\"customMeta\" data-dictid=\"d02faf3d3e16927771998a3442add3\">sustentacular</span> supporting cells <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> clusters (Zell Ballen) encircled by extensive <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> sinusoids.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Elsharawy, Mohamed &amp; Alsaif, Hind &amp; Elsaid, Ayman &amp; Kredees, Ali. \" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Well-defined-nests-of-cuboidal-cells-zellballen-are-separated-by-highly-vascularized_fig5_259272100\" data-tags=\"\" height=\"387\" src=\"https://image.prepladder.com/content/352S51Zmo3isGigC9SI81738820891.png\" width=\"500\"/></p>\n<p><strong> Fig: Zell Ballen Appearance of <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">Glomus</span> Tumor</strong></p>\n<ul>\n<li>Preoperative <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> of the tumour is not performed due to the risk of profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from its highly <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thin-walled blood sinusoids and potential injury to the high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb or <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2iSGpcCS5oJDFag9F42e1745218263.mp3", "video": ""}, {"text": "A 48-year-old woman presents with worsening right ear hearing loss and tinnitus resembling a heartbeat for 6 months. Examination reveals a pulsatile neck mass and a red, bulging tympanic membrane. Biopsy and MRI findings are given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Branchial cyst", "correct": false}, {"label": "B", "text": "Tubercular lymph nodes", "correct": false}, {"label": "C", "text": "Thymic cyst", "correct": false}, {"label": "D", "text": "Paraganglioma", "correct": true}], "correct_answer": "D. Paraganglioma", "question_images": ["https://image.prepladder.com/content/Q3iR5SXho7KLnU5gAy1L1738820956.png", "https://image.prepladder.com/content/n4VrADczHfGURd134HVH1738821035.png"], "explanation_images": ["https://image.prepladder.com/content/hxhIOJVem8KzpVFGj5Vx1738821073.png", "https://image.prepladder.com/content/uHkyAKX28DkbkNZGF5SO1738821101.png", "https://image.prepladder.com/content/TwVbuqXR5CiyDexBLgll1738821121.png", "https://image.prepladder.com/content/2gBpur0MrhcBDcbmjY011738821155.png", "https://image.prepladder.com/content/xUGLJnYdhHWtjhpQLU1K1738821195.png", "https://image.prepladder.com/content/gnOOfukBdroTnkYKWbal1738821309.png", "https://image.prepladder.com/content/nNiGGMf6qEIfYJTnQLWw1738821342.png", "https://image.prepladder.com/content/vXA0ohQllC05hvhr3meM1738821375.png", "https://image.prepladder.com/content/wOeEySSF4qDEsxAtCgSu1738821411.png", "https://image.prepladder.com/content/xU2ACM5Nux0AyArT7jid1738821442.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glomus tumor (Paraganglioma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumors originating from the <span class=\"customMeta\" data-dictid=\"064aee539616927771943ff21f49fa\">paraganglia</span> are known as paragangliomas, with <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumors being a specific type of paraganglioma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tumour type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign (most common <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> tumor of middle ear)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paraganglionic cells or <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> bodies .</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Commonly seen in middle-aged individuals (40-50 years), with a higher <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li><strong>Glomus tympanicum:</strong> Arise from the <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> of the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> (tympanic plexus).</li>\n<li><strong>Glomus jugulare: </strong>Arises from the <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb (sympathetic <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> covering the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein).<strong> </strong></li>\n</ol>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"351\" src=\"https://image.prepladder.com/content/hxhIOJVem8KzpVFGj5Vx1738821073.png\" width=\"500\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Spread </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Inferiorly: </strong>To the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen</li>\n<li><strong>Anteriorly: </strong>Invading into the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> (blockage of <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube)</li>\n<li><strong>Posteriorly: </strong>Invading the mastoid</li>\n<li><strong>Superiorly: </strong>To the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> and middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> (IX-XII <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsy)</li>\n<li><strong>Laterally: </strong>To the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (present as a <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> of the external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal).</li>\n<li><strong>Medially:</strong> Invading the <span class=\"customMeta\" data-dictid=\"7732c8e49d169277719171da17de32\">labyrinth</span> and <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> (dizziness and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy).</li>\n</ul>\n<p><strong> Fig: Spread of <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">Glomus</span> Tumour</strong></p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"438\" src=\"https://image.prepladder.com/content/uHkyAKX28DkbkNZGF5SO1738821101.png\" width=\"500\"/>\n<p><strong>Fig: Spread of <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">Glomus</span> Tumour</strong></p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"342\" src=\"https://image.prepladder.com/content/TwVbuqXR5CiyDexBLgll1738821121.png\" width=\"500\"/>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hearing loss (gradually progressive conductive hearing loss)</li>\n<li>Pulsatile <span class=\"customMeta\" data-dictid=\"1e668dc8ba1692777200622a8a97f3\">tinnitus</span> (heartbeat like sounds): It is <span class=\"customMeta\" data-dictid=\"8a823442c116927771993039b6a37d\">synchronous</span> with pulse and can be temporarily stopped by <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> pressure.</li>\n<li>Bleeding from ear (profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in case of polyp)</li>\n<li>Dizziness or <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> may appear.</li>\n<li>Symptoms like headache, sweating, palpitation, hypertension, anxiety due to <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> (catecholamine release)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Histopathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> (locally invasive)</li>\n<li>HPE reveals<strong> </strong><strong> Zell Ballen pattern,</strong> where <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> chief cells and <span class=\"customMeta\" data-dictid=\"d02faf3d3e16927771998a3442add3\">sustentacular</span> supporting cells <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> clusters (Zell Ballen) encircled by extensive <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> sinusoids.</li>\n<li>Preoperative <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> of the tumour is not performed due to the risk of profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from its highly <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thin-walled blood sinusoids and potential injury to the high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb or <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n</ul>\n<p><img alt=\"\" data-author=\"Elsharawy, Mohamed &amp; Alsaif, Hind &amp; Elsaid, Ayman &amp; Kredees, Ali. \" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Well-defined-nests-of-cuboidal-cells-zellballen-are-separated-by-highly-vascularized_fig5_259272100\" data-tags=\"\" height=\"387\" src=\"https://image.prepladder.com/content/2gBpur0MrhcBDcbmjY011738821155.png\" width=\"500\"/></p>\n<p><strong> Fig: Zell Ballen Appearance of <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">Glomus</span> Tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Otoscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Red <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> through intact <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and bulging <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <strong>(glomus tympanicum).</strong></li>\n<li><strong>“Rising sun\" appearance</strong> due to the tumor originating from the floor of middle ear<strong> (glomus jugulare).</strong></li>\n</ul>\n<img alt=\"\" data-author=\"Michael Hawke MD, Masafumi Ohki, Shigeru Kikuchi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Glomus_Jugulare_Tumor.jpg https://www.researchgate.net/figure/a-A-red-mass-was-observed-under-the-anterior-quadrant-of-the-tympanic-membrane-b_fig1_334371255\" data-tags=\"\" height=\"268\" src=\"https://image.prepladder.com/content/xUGLJnYdhHWtjhpQLU1K1738821195.png\" width=\"500\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CECT (IOC)</strong> shows <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the carotico-jugular spine on the diseased side, known as <strong>Phelp’s sign.</strong></li>\n</ul>\n<img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"509\" src=\"https://image.prepladder.com/content/gnOOfukBdroTnkYKWbal1738821309.png\" width=\"500\"/>\n<p><strong>CT shows <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the left <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> with bone <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> (arrow)</strong></p>\n\t\t\t \n\n\t\t\t<ul>\n<li>MRI scan revealed microhemorrhages within the tumor which appear as white and gray dots on MRI, creating a<strong> \"salt and pepper</strong>\" appearance.</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>MRI shows a well-defined mass (arrow) in the left <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen. The mass shows a \"salt and pepper appearance,</strong></p>\n<img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/nNiGGMf6qEIfYJTnQLWw1738821342.png\" width=\"500\"/> \n\t\t\t<ul>\n<li>Angiography is used to identify the arteries supplying the tumor.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uggZReGUqLhXD3z4MwE01745219341.mp3", "video": ""}, {"text": "A 45-year-old female presents with progressive hearing loss, ear fullness, and occasional tinnitus in her right ear, as well as a faint pulsating sound when lying down. During otoscopy, pressure applied with a Siegel speculum causes the tumor to vibrate vigorously and then blanch. Which sign does this indicate?", "options": [{"label": "A", "text": "Aquinos sign", "correct": false}, {"label": "B", "text": "Phelps sign", "correct": false}, {"label": "C", "text": "Rising sun appearance", "correct": false}, {"label": "D", "text": "Brown sign", "correct": true}], "correct_answer": "D. Brown sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9kGKX10ouCO7OWwP8UDi1738821516.png", "https://image.prepladder.com/content/77ZuF7j9b1OEf4LJHxKu1738821562.png", "https://image.prepladder.com/content/3trBoif3WQqrtRceJg3N1738821611.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs of <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">Glomus</span> Tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pulsation sign or Brown sign</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>When ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> pressure is increased with Siegel's speculum, the tumor pulsates vigorously and then blanches; the opposite occurs when the pressure is released.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aquinos sign </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Applying pressure to the neck compresses the internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, reducing <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> pharyngeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> and the tumor. <strong>This results in a color change of the tumor from red to pale</strong> during otoscopic examination as the blood supply diminishes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phelps sign</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In a CECT scan, the carotico-jugular spine (a dense bony structure between the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> and the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> process) remains intact on the unaffected side. On the<strong> affected side, <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of this spine</strong> is observed.</p>\n<img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/9kGKX10ouCO7OWwP8UDi1738821516.png\" width=\"4092\"/>\n<p>CT shows <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the left <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> with bone <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> (arrow)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Salt pepper appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In an <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> scan, <strong>microhemorrhages</strong> within the tumor are identified as white and gray speckles, creating a characteristic <strong>\"salt-and-pepper\" appearance.</strong></p>\n<img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/77ZuF7j9b1OEf4LJHxKu1738821562.png\" width=\"4167\"/>\n<p>MRI shows a well-defned mass (arrow) in the left <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen. The mass shows a \"salt and pepper appearance,</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rising sun appearance </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> jugulare tumor, <span class=\"customMeta\" data-dictid=\"ebaaf581551692777194d834611cd9\">otoscopy</span> may reveal a <strong>\"rising sun\" appearance</strong> when the tumor originates from the floor of the middle ear.</p>\n<img alt=\"\" data-author=\"Sarafoleanu, Codrut &amp; Bejenariu, Andreea-Elena &amp; Raluca, Enache &amp; Patrascu, Elena\" data-hash=\"\" data-license=\"CC BY-NC-ND 3.0\" data-source=\"https://www.researchgate.net/figure/Reddish-tumor-formation-highlighted-by-the-transparency-of-the-tympanic-membrane_fig1_362074747\" data-tags=\"\" height=\"2951\" src=\"https://image.prepladder.com/content/3trBoif3WQqrtRceJg3N1738821611.png\" width=\"4167\"/>\n<p>On otoscopic examination, the jugulotympanic <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumor appears as a reddish tumor formation highlighted by the transparency of the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, the so-called “rising sun” sign.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HVuoGzrQOewJqaWKb2UX1745219526.mp3", "video": ""}, {"text": "A 50-year-old male presents with progressive hearing loss in his right ear over the past year, accompanied by a sensation of fullness and occasional tinnitus. Examination shows a pulsatile neck mass, and radiology reveals a 5 cm tumour located below the right middle ear. What is the most appropriate management for this condition?", "options": [{"label": "A", "text": "Surgical excision", "correct": false}, {"label": "B", "text": "Embolisation", "correct": false}, {"label": "C", "text": "Radiotherapy", "correct": false}, {"label": "D", "text": "Both A and B", "correct": true}], "correct_answer": "D. Both A and B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transcanal Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For a <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tympanicum tumor where the entire <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the tumor is visible.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypotympanic Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For tumors limited to the <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> and hypotympanum, a superiorly based <span class=\"customMeta\" data-dictid=\"06b5205bd7169277720119ecc5ea59\">tympanomeatal</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> is elevated via a <span class=\"customMeta\" data-dictid=\"1ceec707ae1692777196ec65d07a78\">postauricular</span> approach, and the bony <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> ring is drilled to expose the tumor's lower margin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extended <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">Recess</span> Approach </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is used for small <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tympanicum tumors extending into the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> but not reaching the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb. For more extensive cases, a modified radical <span class=\"customMeta\" data-dictid=\"12d9c7a4041692777191aa892d206f\">mastoidectomy</span> is performed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mastoid-Neck Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>This technique is used for <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> jugulare tumors that do not extend into the internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa, or neck.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infratemporal <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">Fossa</span> Approach (Fisch)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is employed for large <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> jugulare tumors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transcondylar Approach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for tumors extending to the <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> magnum, often <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> jugulare tumors, it provides access to the <span class=\"customMeta\" data-dictid=\"59f950380916927771851ebadcc005\">craniocervical</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> and exposes the <span class=\"customMeta\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\">occipital</span> <span class=\"customMeta\" data-dictid=\"ca4c4e935616927771849e13b0396f\">condyle</span> and <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> tubercle</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6xPnbHTaNvFrpULfRz4Z1745220144.mp3", "video": ""}, {"text": "According to Fisch's classification of glomus tumors, tumors with intracranial invasion measuring less than 2 cm are classified under which type?", "options": [{"label": "A", "text": "Type D2", "correct": false}, {"label": "B", "text": "Type C", "correct": false}, {"label": "C", "text": "Type B", "correct": false}, {"label": "D", "text": "Type D1", "correct": true}], "correct_answer": "D. Type D1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fisch’s <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> for <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours restricted to <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> (Glomus tympanicum tumour)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours restricted to tympanomastoid site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours involving the infra-labyrinth portion towards the <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> apex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type D1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour with <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> invasion (&lt;2cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type D2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour with <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> invasion (&gt;2cm)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gJOVOPMn2XIJbt3pkAfc1745220334.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 10 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 6 year old boy presents with ear pain, and hearing loss for the past 2 days. He also has a recent history of the common cold. Otoscopy shows a retracted tympanic membrane with fluid. What is the most likely cause of his condition?", "options": [{"label": "A", "text": "Barotrauma from rapid pressure changes", "correct": false}, {"label": "B", "text": "Increased secretory activity of the middle ear mucosa", "correct": false}, {"label": "C", "text": "Biofilm formation in the middle ear", "correct": false}, {"label": "D", "text": "Eustachian tube dysfunction", "correct": true}], "correct_answer": "D. Eustachian tube dysfunction", "question_images": ["https://image.prepladder.com/content/uVat6ALLACQHsZxFAvZF1738690252.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bNMu3CLY3mRKrvnrXgIt1745992176.mp3", "video": ""}, {"text": "A 4 year old girl presents with ear pain, fever, and a recent upper respiratory tract infection. On examination, her tympanic membrane is red and bulging. What is the most likely route of infection for her condition?", "options": [{"label": "A", "text": "Through the eustachian tube", "correct": true}, {"label": "B", "text": "Through the external ear", "correct": false}, {"label": "C", "text": "Through the bloodstream", "correct": false}, {"label": "D", "text": "Direct spread from the sinuses", "correct": false}], "correct_answer": "A. Through the eustachian tube", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RsCasiMvmqihSlEGziXD1738690434.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ASOM Etiology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common <span class=\"customMeta\" data-dictid=\"80c0cb2a5f1692777196ba45847553\">Predisposing</span> Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bacterial Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Frequent colds and upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections.</li>\n<li>Tonsil and <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> infections.</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> conditions like <span class=\"customMeta\" data-dictid=\"a8dad7cd171692777197e6d4ac2a1c\">rhinitis</span> and sinusitis.</li>\n<li>Allergies involving the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages.</li>\n<li>Nasopharyngeal tumours or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> for <span class=\"customMeta\" data-dictid=\"26bb4e3cc81692777187ce44e530e5\">epistaxis</span> (nosebleeds).</li>\n<li>Cleft palate</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Streptococcus pneumoniae (30% of cases)</li>\n<li>Haemophilus <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> (20%)</li>\n<li>Moraxella catarrhalis (12%)</li>\n<li>Occasionally, <span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\">Streptococcus</span> pyogenes, <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> aureus, and <span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\">Pseudomonas</span> aeruginosa also contribute.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3Z9YDIuh6p536mpVdLuo1745992377.mp3", "video": ""}, {"text": "A 6 year old with severe earache and fever following an upper respiratory infection presents with a bulging, red tympanic membrane and a yellowish spot. What stage of ASOM is this?", "options": [{"label": "A", "text": "Stage of Tubal Occlusion", "correct": false}, {"label": "B", "text": "Stage of Exudation", "correct": false}, {"label": "C", "text": "Stage of Suppuration", "correct": true}, {"label": "D", "text": "Stage of Resolution", "correct": false}], "correct_answer": "C. Stage of Suppuration", "question_images": ["https://image.prepladder.com/notes/dtFDdrxjVuonqZ7mAQYV1746001113.png"], "explanation_images": ["https://image.prepladder.com/notes/oS8dlFgPasl8PqAqQEvF1746001334.png", "https://image.prepladder.com/notes/Xsj8N543Ad1XXi4yYjiE1746001415.png", "https://image.prepladder.com/notes/aL46dVGj2a66FUnu5L2e1746001274.png", "https://image.prepladder.com/notes/sBI9m5A9yimARMaSVosc1746001502.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:713px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stages of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Suppurative Otitis Media (ASOM)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature &amp; Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage of Tubal Occlusion (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The Eustachian tube becomes blocked due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and increased blood flow, particularly at the <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> end.</li>\n<li>Mild <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> and earache. Usually, no fever is present.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Eardrum retraction, the handle of the <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> becomes horizontal, prominent <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> process of the malleus, and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> light reflex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage of Exudation (Presuppuration) (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>If the Eustachian tube <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> continues, <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">pyogenic</span> bacteria invade the middle ear, leading to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fluid accumulation.</li>\n<li>Symptoms worsen, with significant <span class=\"customMeta\" data-dictid=\"a5203a30961692777186fa0ceba5a7\">earache</span> that may disrupt sleep. <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">Hearing loss</span> and <span class=\"customMeta\" data-dictid=\"1e668dc8ba1692777200622a8a97f3\">tinnitus</span> may occur.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Redness initially on the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa, followed by visible blood vessels along the <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> handle and the eardrum's <span class=\"customMeta\" data-dictid=\"316866040e1692777195f45393e010\">periphery</span> creating a \"cartwheel\" appearance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage of <span class=\"customMeta\" data-dictid=\"56a39e9dae169277719923b12d72d1\">Suppuration</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pus forms in the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> causing the <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> to bulge outward due to the pressure.</li>\n<li>Excruciating earache, increased hearing loss, high fever (up to 102°F-103°F), vomiting, and possible convulsions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>A red, bulging <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> with obscured landmarks,</strong> a hidden <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> handle, and a <span class=\"customMeta\" data-dictid=\"2b3dfc6c971692777202cea51210cd\">yellow spot</span> indicating potential <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> rupture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage of Resolution (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> ruptures spontaneously, releasing <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> and alleviating pressure.</li>\n<li>Relief from <span class=\"customMeta\" data-dictid=\"a5203a30961692777186fa0ceba5a7\">earache</span> and fever as the <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> process subsides. Symptoms improve with <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> drainage.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Blood-tinged <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> initially, becoming mucopurulent.</li>\n<li>A small <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> in the <span class=\"customMeta\" data-dictid=\"237c382dfb1692777181c96284af69\">anteroinferior</span> <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> of the <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">pars</span> tensa is usually visible.</li>\n<li>The eardrum's redness decreases and its landmarks become visible.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage of Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In severe cases, the infection may spread beyond the middle ear, leading to serious complications.</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Potential complications include <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> mastoiditis, <span class=\"customMeta\" data-dictid=\"98c8f7f96f1692777199295afb1d35\">subperiosteal</span> abscess, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> paralysis, labyrinthitis, petrositis, <span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\">extradural</span> abscess, meningitis, brain abscess, and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombophlebitis.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TkrRrlAfoRzcD2x2EYEi1745992633.mp3", "video": ""}, {"text": "A 5-year-old girl presents with severe earache, fever, and discharge from her right ear for 3 days. On examination, her tympanic membrane appears bulging and red. What is the most appropriate initial management for this child?", "options": [{"label": "A", "text": "Myringotomy", "correct": false}, {"label": "B", "text": "Amoxicillin for 5 days", "correct": false}, {"label": "C", "text": "Ephedrine nasal drops", "correct": false}, {"label": "D", "text": "Amoxicillin for 10 days", "correct": true}], "correct_answer": "D. Amoxicillin for 10 days", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u0PnVvzPfJGZ4vwjAfMa1737356473.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Supportive Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Myringotomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Indications</strong>: All cases with fever and severe earache.</li>\n<li><strong>First-line</strong>:\n\t\t\t\t<ul>\n<li>Ampicillin: 50 mg/kg/day in four divided doses.</li>\n<li>Amoxicillin: 40 mg/kg/day in three divided doses.</li>\n</ul>\n</li>\n<li><strong>Penicillin-allergic alternatives</strong>: Cefaclor, Co-trimoxazole, or Erythromycin.</li>\n<li><strong>For β-lactamase-producing H. influenzae or M. catarrhalis</strong>: Amoxicillin-clavulanate, <span class=\"customMeta\" data-dictid=\"ccdefe2f7e169277718419d6bb8958\">Cefuroxime</span> axetil, or Cefixime.</li>\n<li><strong>Duration</strong>: Minimum of 10 days until <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and hearing normalize.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Decongestant <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Drops</strong>:\n\t\t\t\t<ul>\n<li>Ephedrine: 1% (adults), 0.5% (children).</li>\n<li>Oxymetazoline (Nasivion) or Xylometazoline (Otrivin) to reduce <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube edema.</li>\n</ul>\n</li>\n<li><strong>Oral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Decongestants</strong>:\n\t\t\t\t<ul>\n<li>Pseudoephedrine: 30 mg twice daily.</li>\n<li>Combination with antihistaminic: Triominic for children to avoid <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> drops.</li>\n</ul>\n</li>\n<li><strong>Analgesics and Antipyretics</strong>:\n\t\t\t\t<ul>\n<li>Paracetamol: Pain relief and fever reduction.</li>\n<li>Ibuprofen syrup: Alternative for pain and fever.</li>\n</ul>\n</li>\n<li><strong>Ear Toilet</strong>:\n\t\t\t\t<ul>\n<li>Dry mop <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> with <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> cotton buds.</li>\n<li>Insert antibiotic-moistened wick if <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> persists.</li>\n</ul>\n</li>\n<li><strong>Dry Local Heat</strong>:\n\t\t\t\t<ul>\n<li>Pain relief.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Indications</strong>:\n\t\t\t\t<ul>\n<li>Bulging drum with <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> pain.</li>\n<li>Incomplete resolution despite antibiotics (persistent conductive hearing loss).</li>\n<li>Persistent <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> beyond 12 weeks (chronic <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media).</li>\n</ul>\n</li>\n<li>Follow-up: Monitor until the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> normalizes and <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> resolves.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Z3JGv1EhYAa9B4LMi6YF1745992837.mp3", "video": ""}, {"text": "A 7-year-old boy presents with a history of persistent hearing loss over the past 6 months. His parents report that he seems to be asking for the TV to be louder and often complains of a feeling of fullness in his ears. An otoscopic examination reveals a dull, opaque tympanic membrane with decreased mobility in both ears. What is the most likely underlying cause of this child's symptoms?", "options": [{"label": "A", "text": "Cleft palate", "correct": false}, {"label": "B", "text": "Nasopharyngeal carcinoma", "correct": false}, {"label": "C", "text": "Adenoid hyperplasia", "correct": true}, {"label": "D", "text": "Viral infection", "correct": false}], "correct_answer": "C. Adenoid hyperplasia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:678px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malfunctioning of <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Allergy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unresolved <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viral infections</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adenoid hyperplasia</strong>.</li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"a8dad7cd171692777197e6d4ac2a1c\">rhinitis</span> and sinusitis</strong>.</li>\n<li><strong>Chronic tonsillitis</strong>: Enlarged tonsils obstruct the soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> and affect <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube function.</li>\n<li><strong>Nasopharyngeal tumours</strong>: <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">Benign</span> or malignant, especially in adults with <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media.</li>\n<li><strong>Palatal defects</strong>: e.g., <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> palate, <span class=\"customMeta\" data-dictid=\"733f60c2581692777194690224e6eb\">palatal</span> paralysis.</li>\n<li><strong>Down's syndrome</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seasonal or <span class=\"customMeta\" data-dictid=\"231e76e11c1692777195bd586f5b59\">perennial</span> allergies obstruct the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube and increase <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> mucosal secretions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy can lead to persistent, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> infection, stimulating more <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> production and increasing goblet cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><br/>\n\t\t\tAdenoviruses and rhinoviruses can invade the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> mucosa, leading to increased <span class=\"customMeta\" data-dictid=\"9e7aec9ff416927771984a1e3100b7\">secretory</span> activity.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LqUkrDxRcrfZfThpapCW1745993285.mp3", "video": ""}, {"text": "A 15-year-old boy presents with a 2-month history of recurrent nasal obstruction and unilateral ear fullness. On examination, there is serous otitis media in the right ear. What is the most likely cause of this child's condition?", "options": [{"label": "A", "text": "Adenoid hypertrophy", "correct": false}, {"label": "B", "text": "Nasopharyngeal carcinoma", "correct": false}, {"label": "C", "text": "Juvenile Nasopharyngeal Angiofibroma", "correct": true}, {"label": "D", "text": "Chronic sinusitis", "correct": false}], "correct_answer": "C. Juvenile Nasopharyngeal Angiofibroma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PeCXH0siAht0Ork9ciSE1745993667.mp3", "video": ""}, {"text": "A 6 year old child presents with a history of mild hearing loss, difficulty following conversations, and a sensation of fullness in the ear. On examination, the tympanic membrane appears dull and retracted, with visible fluid levels behind it. Which of the following tuning fork test results is most likely to be observed in this patient?", "options": [{"label": "A", "text": "Positive Rinne test and Weber test lateralized to the unaffected ear", "correct": false}, {"label": "B", "text": "Negative Rinne test, Weber test lateralized to the affected ear", "correct": true}, {"label": "C", "text": "Positive Rinne test and Weber test lateralized to the affected ear", "correct": false}, {"label": "D", "text": "Negative Rinne test, Weber test lateralized to the unaffected ear", "correct": false}], "correct_answer": "B. Negative Rinne test, Weber test lateralized to the affected ear", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hearing Loss: Conductive, mild to moderate (20-40 dB), gradual onset, may fluctuate; children may not complain, but parents may notice difficulties in hearing.</li>\n<li>Delayed/Defective Speech</li>\n<li>Mild Earaches</li>\n<li>Fullness in Ear.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Signs </strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tympanic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> Appearance: Dull, opaque, possibly yellow, grey, or bluish; absence of the usual light reflex.</li>\n<li>Visible Fluid/Bubbles: Air-fluid levels or bubbles visible behind the eardrum.</li>\n<li>Retracted <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">Tympanic</span> Membrane: Negative <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> pressure causing <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> retraction, with the <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> handle appearing shortened or horizontal.</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">Tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> Mobility.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rinne Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> (SOM), <span class=\"customMeta\" data-dictid=\"b295cd96751692777183939f64ff6e\">bone conduction</span> is better than <span class=\"customMeta\" data-dictid=\"c6b732e83416927771812e15b4586c\">air conduction</span> (negative Rinne test).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weber Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> (SOM), the sound is louder in the affected ear when the <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> is placed on the forehead.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute <span class=\"customMeta\" data-dictid=\"b295cd96751692777183939f64ff6e\">Bone Conduction</span> (ABC) Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Both patient and examiner hear the <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> for a similar duration when placed on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> bone (ear canals plugged) in <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> (SOM). (Bone <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> not impaired)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schwabach's Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> (SOM), the patient hears the <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> for a longer duration than the examiner when placed on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> bone (ear canals not plugged).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumatic Otoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visualizes <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> movement with air pressure changes; reduced/absent movement indicates fluid presence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impedance audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Measures <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> movement; typically shows a flat/dome-shaped curve with negative pressure, indicating <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> compliance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conductive <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> (20-40 dB).</li>\n<li>Sometimes, associated <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> (d/t fluid on the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> membrane.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray/CT Scan of <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Bone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>May show <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> air cell <span class=\"customMeta\" data-dictid=\"54df5d069d1692777184d80f7b1a7f\">clouding</span> due to fluid</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lySCsMNtteRh0sun7sBa1745993767.mp3", "video": ""}, {"text": "Which of the following tympanometry curves corresponds to Serous Otitis Media?", "options": [{"label": "A", "text": "Curve A", "correct": false}, {"label": "B", "text": "Curve B", "correct": false}, {"label": "C", "text": "Curve C", "correct": true}, {"label": "D", "text": "Curve D", "correct": false}], "correct_answer": "C. Curve C", "question_images": ["https://image.prepladder.com/content/CqXtWlfwiLDtJivFVrdk1737357135.png"], "explanation_images": ["https://image.prepladder.com/content/xK6WYBbzujKQOYDEcdOC1737357051.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/L3Fqsiv7NaPJaXj2ROZq1745993917.mp3", "video": ""}, {"text": "A 5 year old child diagnosed with serous otitis media has persistent middle ear fluid despite medical treatment and even myringotomy and fluid aspiration. Which of the following is the next appropriate step in management?", "options": [{"label": "A", "text": "Continued use of systemic decongestants", "correct": false}, {"label": "B", "text": "Grommet insertion", "correct": true}, {"label": "C", "text": "Oral antibiotics for 2 weeks", "correct": false}, {"label": "D", "text": "Tympanotomy with mastoidectomy", "correct": false}], "correct_answer": "B. Grommet insertion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Decongestants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Topical or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> decongestants relieve <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube oedema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiallergic Measures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Use of antihistamines or steroids; <span class=\"customMeta\" data-dictid=\"7396dd35a41692777181bd7038fa9b\">allergen</span> <span class=\"customMeta\" data-dictid=\"d61e782bf41692777182f829eef312\">avoidance</span> or desensitisation if possible.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Useful for treating upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections or unresolved <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media. <strong>(Option C ruled out) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle Ear Aeration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Techniques include the Valsalva manoeuvre, politzerization, <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube catheterization, insufflation, and chewing <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">gum</span> to open the tube.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myringotomy and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> of Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> in the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> to <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> fluid; thick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> may require <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> or <span class=\"customMeta\" data-dictid=\"d3957bd7ec16927771931064fb9a0a\">mucolytic</span> agents like <span class=\"customMeta\" data-dictid=\"97961809dc169277718451f3dd34f5\">chymotrypsin</span> solution.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grommet Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If fluid recurs after <span class=\"customMeta\" data-dictid=\"43046dc2c016927771930d2538e6d6\">myringotomy</span> and aspiration, a <span class=\"customMeta\" data-dictid=\"efcdc8d2f71692777188341ac61941\">grommet</span> is inserted for continued <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> aeration; remains in place for weeks or months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tympanotomy or <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">Cortical</span> Mastoidectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Required for removing loculated thick fluid or other pathologies like cholesterol granuloma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Treatment of <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">Causative</span> Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Procedures like adenoidectomy, tonsillectomy, and/or maxillary <span class=\"customMeta\" data-dictid=\"880f5f4246169277718114f14f7cbf\">antra</span> <span class=\"customMeta\" data-dictid=\"67d67b341916927772029cd0d951df\">washout</span> may be needed, typically performed during myringotomy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/P3P7fmrMOKWiXRptFH6F1745994050.mp3", "video": ""}, {"text": "A 4 year old child presents with a history of ear discomfort and hearing loss. On examination, the tympanic membrane is dull and retracted, with visible air-fluid levels behind it. The child has no fever or systemic symptoms. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute Suppurative Otitis Media", "correct": false}, {"label": "B", "text": "Serous Otitis Media", "correct": true}, {"label": "C", "text": "Otitis Externa", "correct": false}, {"label": "D", "text": "Chronic Suppurative Otitis Media", "correct": false}], "correct_answer": "B. Serous Otitis Media", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">Suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> Media (ASOM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serous <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> Media (SOM)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the middle ear.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Accumulation of non-purulent fluid in the middle ear; also called <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> Media with <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">Effusion</span> (OME).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mainly bacterial (e.g., <span class=\"customMeta\" data-dictid=\"9562e26acc16927771995a2028dd05\">Streptococcus</span> pneumoniae, <span class=\"customMeta\" data-dictid=\"e8810d5c6b169277718827849b05a3\">Haemophilus</span> influenzae, <span class=\"customMeta\" data-dictid=\"e641ced0f016927771926ee6999bbb\">Moraxella</span> catarrhalis).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eustachian tube <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> due to <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infections, allergies, or enlarged adenoids; also can be due to unresolved AOM or <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid onset of pain, red/bulging <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, fever, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often subtle: <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> (conductive), mild earaches, feeling of fullness, delayed speech.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Purulent (contains pus).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-purulent fluid.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Key Distinctions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presence of Pus:</strong> ASOM has <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presence of Fluid:</strong> SOM has non-purulent fluid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptom Severity:</strong> ASOM has severe, rapid-onset symptoms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptom Severity:</strong> SOM has more subtle, gradual symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Requires antibiotics for bacterial infection.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May involve decongestants, antihistamines, and addressing underlying causes; antibiotics are not typically needed.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zXWD3ffyGpDbh0Z0blBV1745994165.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - 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Otosclerosis primarily affects the region of the fissula ante fenestram, located anterior to the round window. The bony labyrinth is involved in otosclerosis, but the membranous labyrinth usually remains unaffected. Peri-otic duct is filled with endolymph. Otic capsule ossifies from 2 centers.", "options": [{"label": "A", "text": "2 only", "correct": true}, {"label": "B", "text": "1, 2, and 3 only", "correct": false}, {"label": "C", "text": "2 and 4 only", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "A. 2 only", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZCaraFoe4Ryv8Q1U9lD91738819635.png", "https://image.prepladder.com/content/vOqDtw5UqJFMn04eGC5L1738819705.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8wmpndhFFPKuESra1ZxN1745423864.mp3", "video": ""}, {"text": "Which of the following is NOT a characteristic of the inactive phase of otosclerosis?", "options": [{"label": "A", "text": "Dense hypercellular bone", "correct": false}, {"label": "B", "text": "Excessive osteoclast activity", "correct": true}, {"label": "C", "text": "Mineralized sclerotic bone", "correct": false}, {"label": "D", "text": "Minimal remodeling", "correct": false}], "correct_answer": "B. Excessive osteoclast activity", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histological features </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Active phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by</p>\n<ul>\n<li><strong>Vascular proliferation</strong></li>\n<li>Excessive <span class=\"customMeta\" data-dictid=\"c182a5c58f1692777197ad47b9c2ef\">remodeling</span> <strong>(Option B)</strong></li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> and <span class=\"customMeta\" data-dictid=\"8e55f8d71d1692777194a10c3d3d9d\">osteoblast</span> activity.</li>\n</ul>\n<p>The bone becomes <strong>spongy</strong> in appearance due to fibroblasts and histiocytes in the stroma, leading to the term <strong>otospongiosis</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The new blood vessels are surrounded by a layer of new bone which <strong>stains blue </strong>on <span class=\"customMeta\" data-dictid=\"758c1df9711692777188d750598c90\">H and E</span> <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> hence known as <strong>the blue <span class=\"customMeta\" data-dictid=\"5ec65d4890169277719136decb922c\">mantle</span> of Manasse</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inactive phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked by dense, hypercellular, <strong>sclerotic bone,</strong> with minimal remodeling</p>\n<p><strong>(Options A, C</strong>,<strong> D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mature <span class=\"customMeta\" data-dictid=\"e2071f8f891692777203982b3fa0f5\">foci</span> show less <span class=\"customMeta\" data-dictid=\"05493772261692777201c10c4ee537\">vascularity</span> and lay off more bone and more of fibrillar substance than <span class=\"customMeta\" data-dictid=\"f69fb3235e1692777184c7d95ed35f\">cementum</span> and are <strong>stained red.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pOMRHuNwXc17tQKLHVhG1745424205.mp3", "video": ""}, {"text": "A 45-year-old patient presents with progressive conductive hearing loss. During a stapedectomy, the surgeon notes that the stapes footplate is fixed, but the annular ligament remains free. Which type of stapedial otosclerosis is most likely present in this patient?", "options": [{"label": "A", "text": "Posterior focus", "correct": false}, {"label": "B", "text": "Circumferential type", "correct": false}, {"label": "C", "text": "Biscuit type", "correct": true}, {"label": "D", "text": "Obliterative type", "correct": false}], "correct_answer": "C. Biscuit type", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bvDXfDtz6thrT5GBRrLH1738819757.png", "https://image.prepladder.com/content/u1gVuJCidUXTNk51LeOs1738819778.png", "https://image.prepladder.com/content/mkIFKUQ8Z3ArEXtqLnYW1738819950.png", "https://image.prepladder.com/content/2ODHFjL2T4tCL5E2qNn81738819826.png", "https://image.prepladder.com/content/9S7irjrAZiq9BJIknhyS1738819854.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Site of the lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anterior focus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Front of the <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> window in an area called <strong>“fissula <span class=\"customMeta\" data-dictid=\"bcbdab61851692777181c3bb7fd882\">ante</span> fenestram”</strong></p>\n<p><strong>Most common type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1723\" src=\"https://image.prepladder.com/content/bvDXfDtz6thrT5GBRrLH1738819757.png\" width=\"1833\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Posterior focus </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Behind the <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> window</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1744\" src=\"https://image.prepladder.com/content/u1gVuJCidUXTNk51LeOs1738819778.png\" width=\"1814\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Circumferential </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Around the margin</strong> of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1870\" src=\"https://image.prepladder.com/content/mkIFKUQ8Z3ArEXtqLnYW1738819950.png\" width=\"1944\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Biscuit type</strong><strong> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In the <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> the <strong>annular <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> is free</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1581\" src=\"https://image.prepladder.com/content/2ODHFjL2T4tCL5E2qNn81738819826.png\" width=\"1540\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Obliterative type </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Completely obliterates the <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> window niche</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1593\" src=\"https://image.prepladder.com/content/9S7irjrAZiq9BJIknhyS1738819854.png\" width=\"1696\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3Ck0FjI1DLQLNzRTHDDr1745424417.mp3", "video": ""}, {"text": "A 35-year-old woman presents with progressive hearing loss. She reports that she hears better in noisy environments, such as when talking to people in crowded places. This phenomenon is known as:", "options": [{"label": "A", "text": "Paracusis Willisii", "correct": true}, {"label": "B", "text": "Presbycusis", "correct": false}, {"label": "C", "text": "Hyperacusis", "correct": false}, {"label": "D", "text": "Diplacusis", "correct": false}], "correct_answer": "A. Paracusis Willisii", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5klqYjtpJeEXatnHaNf41738820027.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dyNvZ2nxCKrL8TPpwjxG1745953788.mp3", "video": ""}, {"text": "A 50-year-old man reports progressive hearing loss without tinnitus or vertigo. Otoscopy shows a normal tympanic membrane. Audiometry reveals a low-frequency air-bone gap with preserved speech discrimination. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cochlear otosclerosis", "correct": false}, {"label": "B", "text": "Stapedial otosclerosis", "correct": true}, {"label": "C", "text": "Presbycusis", "correct": false}, {"label": "D", "text": "Tympanosclerosis", "correct": false}], "correct_answer": "B. Stapedial otosclerosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stapedial Otosclerosis (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cochlear <span class=\"customMeta\" data-dictid=\"8f7b2677d71692777194eba45432d3\">Otosclerosis</span> (Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stapes <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> (attached to the <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> window)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bony <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> of the cochlea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hearing loss type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conductive hearing loss</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensorineural hearing loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Effect on sound transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restricts movement of the stapes, impairing sound vibrations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disrupts cochlear structures, impairing signal conversion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vestibular symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent in most cases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertigo or <span class=\"customMeta\" data-dictid=\"21b3779eca1692777186ec4f369d76\">dizziness</span> in some cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Frequency of hearing loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower frequencies affected first</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher frequencies affected first</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tympanic membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Other symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tinnitus (ringing in the ears)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0bEYfKKTqV4jEguoRLOn1746545712.mp3", "video": ""}, {"text": "A 40-year-old woman with early-stage otosclerosis presents with progressive conductive hearing loss and a normal tympanic membrane. Which CT finding indicates the active phase of the disease?", "options": [{"label": "A", "text": "Dense sclerotic bone around the stapes footplate", "correct": false}, {"label": "B", "text": "Lucent (hypodense) foci in the otic capsule near the stapes footplate", "correct": true}, {"label": "C", "text": "Erosion of the cochlear capsule with hypodense areas", "correct": false}, {"label": "D", "text": "Normal bone density with no abnormalities", "correct": false}], "correct_answer": "B. Lucent (hypodense) foci in the otic capsule near the stapes footplate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Hzultk3auGYjws0i8N681738820111.png", "https://image.prepladder.com/content/OlSBqBwWeiIWdLv7Gx3v1738820179.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nJtB5RK4BktMtz9mdMT01746643589.mp3", "video": ""}, {"text": "A 35-year-old patient presents with sensorineural hearing loss. Pure-tone audiometry shows a sloping loss, and bone conduction testing shows a normal Carhart effect. High-resolution CT scan identifies otosclerotic foci but does not show clear cochlear changes. What does this finding suggest?", "options": [{"label": "A", "text": "The CT scan results confirm a diagnosis of cochlear otosclerosis.", "correct": false}, {"label": "B", "text": "The normal Carhart effect suggests that cochlear otosclerosis is unlikely.", "correct": false}, {"label": "C", "text": "Cochlear otosclerosis should be considered despite the CT scan's inability to show cochlear changes.", "correct": true}, {"label": "D", "text": "The sloping audiometric pattern rules out cochlear otosclerosis.", "correct": false}], "correct_answer": "C. Cochlear otosclerosis should be considered despite the CT scan's inability to show cochlear changes.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/D5Lh8vL56CbhRGTOCVbr1746643418.mp3", "video": ""}, {"text": "A patient who underwent stapedectomy for otosclerosis returns with complaints of dizziness and taste disturbances. Which of the following is a possible complication of stapedectomy that could explain these symptoms?", "options": [{"label": "A", "text": "Progressive cochlear hearing loss", "correct": false}, {"label": "B", "text": "Persistent tinnitus", "correct": false}, {"label": "C", "text": "Reparative granuloma", "correct": true}, {"label": "D", "text": "Infection following surgery", "correct": false}], "correct_answer": "C. Reparative granuloma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/f2AUJTDFL2ee5CjLzdWh1746546272.mp3", "video": ""}, {"text": "A 45-year-old male presents with progressive hearing loss in his left ear over the past few years. Audiometry shows hearing loss predominantly in lower frequencies, and otoscopic examination reveals a normal tympanic membrane. The patient denies experiencing tinnitus or vertigo. The patient’s hearing loss is mild and not significantly affecting his daily life. What is the most appropriate initial management strategy for this patient?", "options": [{"label": "A", "text": "Immediate stapedectomy surgery", "correct": false}, {"label": "B", "text": "Bisphosphonates", "correct": false}, {"label": "C", "text": "Observation and monitoring", "correct": true}, {"label": "D", "text": "Sodium fluoride therapy", "correct": false}], "correct_answer": "C. Observation and monitoring", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benefits</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sodium <span class=\"customMeta\" data-dictid=\"7cdfdfcdc616927772026ac0b8d995\">Fluoride</span> (NaF) </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stabilizes hearing thresholds and <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> symptoms. Combined with <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"fdae4d6e3a1692777183b5745d0c02\">carbonate</span> and <span class=\"customMeta\" data-dictid=\"77a4f731501692777202a03bfca9b4\">vitamin D</span> for enhanced effect.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At least 6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delays worsening tinnitus</p>\n<p>Reduces conductive and <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> hearing loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bisphosphonates </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stabilizes hearing loss, reduces <span class=\"customMeta\" data-dictid=\"21b3779eca1692777186ec4f369d76\">dizziness</span> and tinnitus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At least 6 months</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stabilizes hearing loss</p>\n<p>Relieves <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> symptoms</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/IdS5ackfTReVhSfwnLBX1745994868.mp3", "video": ""}, {"text": "A 50-year-old patient is scheduled for a stapedectomy to treat stapedial otosclerosis. Which of the following statements about the stapedectomy procedure is false?", "options": [{"label": "A", "text": "Small incision is made in the ear canal or behind the ear", "correct": false}, {"label": "B", "text": "Stapes bone along with its footplate is removed.", "correct": false}, {"label": "C", "text": "A metal or plastic prosthetic device replaces the stapes.", "correct": false}, {"label": "D", "text": "Lower complication rate", "correct": true}], "correct_answer": "D. Lower complication rate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NuBgeuPnjCqjKJHIbon91738820252.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small opening made in the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate; a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> is inserted.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> rates; preferred by many otologists.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete removal of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> bone; replaced with a <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> device.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of complications.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rhoDT6ZXElNyTpTxG7vW1745902990.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 20 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 23 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 60-year-old patient presents with hearing issues. During the examination, the audiologist performs the Bing Test and Gelle’s Test to assess the type of hearing loss. What would be indicative of conductive hearing loss in the Bing and Gelle tests?", "options": [{"label": "A", "text": "Bing: No change; Gelle: No change", "correct": true}, {"label": "B", "text": "Bing: Louder; Gelle: Decreased", "correct": false}, {"label": "C", "text": "Bing: Louder; Gelle: No change", "correct": false}, {"label": "D", "text": "Bing: No change; Gelle: Decreased", "correct": false}], "correct_answer": "A. Bing: No change; Gelle: No change", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bing Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gelle's Test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess the effect of ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> on <span class=\"customMeta\" data-dictid=\"b295cd96751692777183939f64ff6e\">bone conduction</span> (BC) hearing.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates the effect of increased air pressure in the ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> on BC hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> is placed on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> while the ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> is alternately occluded and unoccluded.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> is placed on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> while the air pressure in the ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> is increased using Siegel’s <span class=\"customMeta\" data-dictid=\"88d9723257169277719536cf89e5a9\">pneumatic</span> speculum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal/SNHL Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sound appears louder when the ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> is occluded. <strong>(Positive)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hearing decreases with increased air pressure <strong>(Positive)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conductive Loss Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No change in sound loudness with ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> occlusion. <strong>(Negative)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No change in hearing with increased air pressure <strong>(Negative)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rTLkAp7jWDEcwbw7NYuK1741765772.mp3", "video": ""}, {"text": "A 68-year-old retired librarian has experienced a gradual decline in hearing ability in her right ear. She attributes this issue to ageing and consults an audiologist. The test results show a hearing level of 67 dB in her right ear. What is the grade of her hearing loss?", "options": [{"label": "A", "text": "Mild", "correct": false}, {"label": "B", "text": "Moderate", "correct": false}, {"label": "C", "text": "Moderately severe", "correct": true}, {"label": "D", "text": "Severe", "correct": false}], "correct_answer": "C. Moderately severe", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Grade Range Mild (Option A) 26-40 dB Moderate (Option B) 41-55 dB Moderately severe (Option C) 56-70 dB Severe (Option D) 71-91 dB Profound &gt;91 dB</li><li>↳ Grade Range</li><li>↳ Grade</li><li>↳ Grade</li><li>↳ Grade</li><li>↳ Range</li><li>↳ Range</li><li>↳ Range</li><li>↳ Mild (Option A) 26-40 dB</li><li>↳ Mild (Option A)</li><li>↳ Mild (Option A)</li><li>↳ (Option A)</li><li>↳ 26-40 dB</li><li>↳ 26-40 dB</li><li>↳ Moderate (Option B) 41-55 dB</li><li>↳ Moderate (Option B)</li><li>↳ Moderate (Option B)</li><li>↳ (Option B)</li><li>↳ 41-55 dB</li><li>↳ 41-55 dB</li><li>↳ Moderately severe (Option C) 56-70 dB</li><li>↳ Moderately severe (Option C)</li><li>↳ Moderately severe (Option C)</li><li>↳ (Option C)</li><li>↳ 56-70 dB</li><li>↳ 56-70 dB</li><li>↳ Severe (Option D) 71-91 dB</li><li>↳ Severe (Option D)</li><li>↳ Severe (Option D)</li><li>↳ (Option D)</li><li>↳ 71-91 dB</li><li>↳ 71-91 dB</li><li>↳ Profound &gt;91 dB</li><li>↳ Profound</li><li>↳ Profound</li><li>↳ Profound</li><li>↳ &gt;91 dB</li><li>↳ &gt;91 dB</li><li>↳ &gt;91 dB</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:538px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Range </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>26-40 dB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>41-55 dB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderately severe <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>56-70 dB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>71-91 dB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Profound </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>&gt;91 dB </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fGDd5IF2UnYUDasm09es1741681153.mp3", "video": ""}, {"text": "A 45-year-old female with a recent upper respiratory infection presented with ear pain, fullness, hearing difficulties, and dizziness, along with increased pressure during flights and bending over. Which of the following tests is most reliable in this condition?", "options": [{"label": "A", "text": "Valsalva test", "correct": false}, {"label": "B", "text": "Tympanometry", "correct": true}, {"label": "C", "text": "Politzer test", "correct": false}, {"label": "D", "text": "Toynbee’s test", "correct": false}], "correct_answer": "B. Tympanometry", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ws3n54ZCLGIniubbxlxr1738823938.png", "https://image.prepladder.com/content/eetKEPr0JSTdN02v46Ly1738824002.png", "https://image.prepladder.com/content/1jWrt4vyBiRAXpSxHh9V1738824031.png", "https://image.prepladder.com/content/uOHy2U6e660DEUwRGUPF1738824070.png", "https://image.prepladder.com/content/ZjhywiFZcjpHFaDQ8Kfb1738824114.png", "https://image.prepladder.com/content/qLydhIT9DTnidEW53TSC1738824151.png", "https://image.prepladder.com/content/baDPpfScI7WveTHeomeg1738824188.png", "https://image.prepladder.com/content/OOzjeryaP3QIYwKjp4Cu1738824208.png", "https://image.prepladder.com/content/WeHGGIccnOhhr0K7xdez1738824240.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:686px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tympanometry/Inflation-deflation test </strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Principle: When a sound strikes the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, some of the sound energy is absorbed while the rest is reflected.</li>\n<li><strong>Normal: </strong>The ability of the tube to equilibrate positive and negative pressures to the <span class=\"customMeta\" data-dictid=\"d3495799cb16927771819a4eab9793\">ambient</span> pressure.</li>\n</ul>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1099\" src=\"https://image.prepladder.com/content/ws3n54ZCLGIniubbxlxr1738823938.png\" width=\"2281\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumatic otoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane</strong> (tested by <span class=\"customMeta\" data-dictid=\"286d894b461692777194849ba2b56d\">otoscope</span> or Siegle’s speculum): Mobile, shiny, pearly grey, has a <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> surface (umbo) and a bright light <span class=\"customMeta\" data-dictid=\"1c42c9fe83169277718486ee5a82e9\">cone</span> in the <span class=\"customMeta\" data-dictid=\"237c382dfb1692777181c96284af69\">anteroinferior</span> quadrant.</p>\n<p><img alt=\"\" data-author=\"Anonymous user\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://www.wikidoc.org/index.php/File:Flexibles_Endoskop.jpg\" data-tags=\"\" height=\"2045\" src=\"https://image.prepladder.com/content/eetKEPr0JSTdN02v46Ly1738824002.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasopharyngoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A flexible <span class=\"customMeta\" data-dictid=\"9ce72b40531692777193cda1ab37f2\">nasopharyngoscope</span> can examine the pharyngeal end of the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube.</p>\n<img alt=\"\" data-author=\"Sun, Haiying &amp; Yuan, Jie &amp; Cheng, Qing &amp; Hu, Juanjuan &amp; Han, Nana &amp; Yi, Lisha &amp; Zhu, Yun\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"Flexible nasopharyngoscopy examination of nasopharynx. (A, B) In case... | Download Scientific Diagram (researchgate.net)\" data-tags=\"\" height=\"3168\" src=\"https://image.prepladder.com/content/1jWrt4vyBiRAXpSxHh9V1738824031.png\" width=\"4167\"/>\n<p><img alt=\"\" data-author=\"Sun, Haiying &amp; Yuan, Jie &amp; Cheng, Qing &amp; Hu, Juanjuan &amp; Han, Nana &amp; Yi, Lisha &amp; Zhu, Yun\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"Flexible nasopharyngoscopy examination of nasopharynx. (A, B) In case... | Download Scientific Diagram (researchgate.net)\" data-tags=\"\" height=\"2610\" src=\"https://image.prepladder.com/content/uOHy2U6e660DEUwRGUPF1738824070.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eustachian tube catheterisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A bent <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> is passed through the nose to the nasopharynx, where a Politzer's bag is connected to insufflate air. Entry of air into the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> is confirmed using an <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> tube.</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1504\" src=\"https://image.prepladder.com/content/ZjhywiFZcjpHFaDQ8Kfb1738824114.png\" width=\"2447\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Valsalva </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Principle:</strong> Create <span class=\"customMeta\" data-dictid=\"3121d7693a169277719696af2cead1\">positive pressure</span> in the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> to allow air into the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube.</li>\n<li>Pinching the nose and taking a deep breath with a closed mouth helps blow air into the ears, moving the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> outward.</li>\n<li><strong>Contraindication: <span class=\"customMeta\" data-dictid=\"32a1e3c77516927771956ec2bbac4c\">Pharyngitis</span> and sinusitis</strong></li>\n</ul>\n<img alt=\"\" data-author=\"U.S. Air Force photo by Airman 1st Class Kate Thornton\" data-hash=\"\" data-license=\"Open access\" data-source=\"Valsalva maneuver - Valsalva maneuver - Wikipedia\" data-tags=\"\" height=\"3321\" src=\"https://image.prepladder.com/content/qLydhIT9DTnidEW53TSC1738824151.png\" width=\"4167\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Politzer test </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In children who can't perform the Valsalva test, the olive-shaped tip of a Politzer's bag is used; compressing the bag causes the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> to bulge.</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"3015\" src=\"https://image.prepladder.com/content/baDPpfScI7WveTHeomeg1738824188.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toynbee manoeuvre</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Toynbee’s manoeuvre causes a <span class=\"customMeta\" data-dictid=\"befa0a72121692777193663f2ca836\">negative pressure</span> in the nasopharynx, causing inward <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> of the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1236\" src=\"https://image.prepladder.com/content/OOzjeryaP3QIYwKjp4Cu1738824208.png\" width=\"2488\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frenzel manoeuvre</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Performed by divers to equalise <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> pressure underwater.</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1744\" src=\"https://image.prepladder.com/content/WeHGGIccnOhhr0K7xdez1738824240.png\" width=\"2449\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sonotubometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube opening by applying sound through a <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> and recording changes in the external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> during swallowing.</p>\n<img alt=\"\" custommeta\"=\"\" data-author=\"A. Borangiu, Cr Popescu, VI Purcarea\" data-dictid=\"22053f7eef1692777187c1142bad20\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"(PDF) Sonotubometry, a useful tool for the evaluation of the &lt;span class=\"/>Eustachian tube ventilatory function (researchgate.net)\" data-tags=\"\" height=\"1846\" src=\"https://image.prepladder.com/content/E9C9cWQOYfV5mq5ScXkI1738824277.png\" width=\"4167\" /&gt;</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ID9XgYPEkqReNzSwIMXX1741681489.mp3", "video": ""}, {"text": "A 7-year-old boy is referred to the ENT clinic for difficulty hearing in noisy environments and discomfort from loud sounds, affecting his school performance. Which of the following indicates cochlear pathology?", "options": [{"label": "A", "text": "Absence of stapedial reflex", "correct": false}, {"label": "B", "text": "Threshold tone decay &amp;gt;25 dB", "correct": false}, {"label": "C", "text": "SISI score 0-20%", "correct": false}, {"label": "D", "text": "Presence of recruitment", "correct": true}], "correct_answer": "D. Presence of recruitment", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/q5QUxQc90JwnK7gJe5no1738823856.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:705px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Example </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Use </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The ear that fails to detect low-intensity sounds begins to perceive higher-intensity sounds at levels as loud as or louder than those heard by a normal ear. As a result, a sound that is tolerable in a normal ear may become uncomfortably loud in the recruiting ear.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cochlear lesions:</p>\n<ul>\n<li>Meniere’s disease</li>\n<li>Presbycusis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distinguish cochlear <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> from retrocochlear.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:702px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cochlear pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retrocochlear pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Speech discrimination</strong></p>\n<p><strong>score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90-100%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Below 90%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very poor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recruitment</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SISI score</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-15%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;70%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Threshold tone decay</strong></p>\n<p><strong>Test</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-15 dB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;25 dB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;25 dB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedial reflex</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedial <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> decay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BERA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal interval between wave I and V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal interval between wave I and V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wave V delayed or absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rollover phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent primarily but seen in old age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vDM39XHJsQbMQDsG28cY1741682353.mp3", "video": ""}, {"text": "A 4-month-old was brought to the audiology clinic by his parents due to decreased responsiveness to environmental sounds, such as his name and household noises. Audiology tests were recommended. Which statement about the test shown in the image is correct?", "options": [{"label": "A", "text": "Emissions are generated by inner hair cells", "correct": false}, {"label": "B", "text": "Spontaneous emissions are present in all individuals", "correct": false}, {"label": "C", "text": "Evaluates hearing in those with cognitive impairments", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. Evaluates hearing in those with cognitive impairments", "question_images": ["https://image.prepladder.com/notes/38nMcDhKowfDbdMaLjSq1741762809.png"], "explanation_images": ["https://image.prepladder.com/notes/2C6QKLRuvjfnyy7ZAYT91741763382.png", "https://image.prepladder.com/content/ozdX2GiU4CK2qYd6dWtX1738823728.png", "https://image.prepladder.com/content/PIgEWoSUWEFLmDoJmeSE1738823759.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NkYNHD3paeuOtR58v9DK1745603284.mp3", "video": ""}, {"text": "An infant was brought in due to concerns from her parents about her poor response to loud sounds and reduced reaction to environmental noises compared to her peers. The BERA test shows issues with wave V within the first 10 milliseconds. What site of pathology might this indicate?", "options": [{"label": "A", "text": "Cochlear nucleus", "correct": false}, {"label": "B", "text": "Superior olivary complex", "correct": false}, {"label": "C", "text": "Lateral lemniscus", "correct": true}, {"label": "D", "text": "Inferior colliculus", "correct": false}], "correct_answer": "C. Lateral lemniscus", "question_images": ["https://image.prepladder.com/content/MjGCeRNjw3IzRqZfYLY21738823543.png"], "explanation_images": ["https://image.prepladder.com/content/Lf6P3s9ynr02AwEtAQOe1738823569.png", "https://image.prepladder.com/content/ExzQeNuIs8J2mWEhfG981738823600.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wave I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distal part of CN VIII</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wave II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal part of CN VIII near the brainstem</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wave III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cochlear <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wave IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"faa9349bf41692777194f3ea36ab45\">olivary</span> complex <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wave V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"62a3d7acd416927771913ad82a2607\">lemniscus</span> (Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wave VI and VII </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior <span class=\"customMeta\" data-dictid=\"1bbc05a9c216927771844ff032232d\">Colliculus</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pQDFMARCpzc2LZnfrMCo1741682803.mp3", "video": ""}, {"text": "Which of the following is NOT true about Electrocochleography(ECochG)?", "options": [{"label": "A", "text": "Measures the electrical potentials generated in the cochlea and 8th cranial nerve", "correct": false}, {"label": "B", "text": "A normal SP/AP ratio is greater than 0.3 or 30%", "correct": true}, {"label": "C", "text": "Can differentiate cochlear pathology from 8th nerve lesions", "correct": false}, {"label": "D", "text": "Investigation of choice for Meniere's disease", "correct": false}], "correct_answer": "B. A normal SP/AP ratio is greater than 0.3 or 30%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/EVD3fUbyj53N8f7t64ui1741683021.mp3", "video": ""}, {"text": "A 5-year-old child undergoes acoustic reflex testing during an evaluation for suspected hearing loss. The results indicate the absence of stapedial reflexes at elevated sound levels. Which of the following is the most likely interpretation of this finding?", "options": [{"label": "A", "text": "Normal hearing with no middle ear pathology", "correct": false}, {"label": "B", "text": "Conductive hearing loss", "correct": true}, {"label": "C", "text": "Mild sensorineural hearing loss", "correct": false}, {"label": "D", "text": "Lesion in auditory cortex", "correct": false}], "correct_answer": "B. Conductive hearing loss", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SomPmffoSEChuQ73rrFH1738823489.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/z8Ay19DJOH3tviaGeJ6k1741684048.mp3", "video": ""}, {"text": "A 55-year-old patient with a history of chronic otitis media presents with progressive hearing loss. Impedance audiometry is performed. Which of the following findings would be pointing towards an underlying middle ear pathology?", "options": [{"label": "A", "text": "Type A tympanogram", "correct": false}, {"label": "B", "text": "Type B tympanogram", "correct": true}, {"label": "C", "text": "A decreased physical volume of the external auditory canal", "correct": false}, {"label": "D", "text": "The presence of a robust acoustic reflex at normal sound intensities", "correct": false}], "correct_answer": "B. Type B tympanogram", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qLgq3dwK2DraBPHNNZP71738823391.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tympanogram Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal peak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type As</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shallow peak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ossicular <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., otosclerosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type Ad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deep peak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ossicular discontinuity or thin <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flat, no peak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Middle ear fluid or thick <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peak at negative pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eustachian tube dysfunction, <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> negative pressure</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hFsj7k2nVdaid4SM8Uo91741684404.mp3", "video": ""}, {"text": "A 48-year-old woman presents with progressive left ear hearing loss. Audiometry reveals a characteristic dip in the bone conduction curve, more pronounced at 2000 Hz. Which of the following best describes this finding?", "options": [{"label": "A", "text": "Carhart's notch", "correct": true}, {"label": "B", "text": "Boiler's notch", "correct": false}, {"label": "C", "text": "Age-related hearing loss", "correct": false}, {"label": "D", "text": "Meniere's disease", "correct": false}], "correct_answer": "A. Carhart's notch", "question_images": ["https://image.prepladder.com/content/ChsrhRfoE393aqB1Yogj1738823183.png"], "explanation_images": ["https://image.prepladder.com/content/6zV9QXach3Rb2tu5JqXG1738823211.png", "https://image.prepladder.com/content/lLduQ4GMigE6IuyF7H8c1738823243.png", "https://image.prepladder.com/content/b8XGaFdrU44f1yJQRUw21738823277.png", "https://image.prepladder.com/content/OZ87y3rimYjngQiIJROb1738823298.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Otosclerosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Noise-Induced <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">Hearing Loss</span> (NIHL)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Air Conduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss, more pronounced at lower frequencies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> and Characteristic pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal, may show <strong>\"Carhart's notch\"</strong> at 2000 Hz (5-15 dB loss)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typical <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">notch</span> at 4000 Hz in both air and <span class=\"customMeta\" data-dictid=\"b295cd96751692777183939f64ff6e\">bone conduction</span> <strong>(Boiler's notch) </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensorineural</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/6zV9QXach3Rb2tu5JqXG1738823211.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/lLduQ4GMigE6IuyF7H8c1738823243.png\" width=\"4167\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rg9ee3p9AzDn00IYrX5r1741684604.mp3", "video": ""}, {"text": "A 45-year-old patient reports difficulty hearing in the Right ear. Pure tone audiometry is done and the result is given in the image below. Given the audiometric findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Conductive Hearing Loss", "correct": true}, {"label": "B", "text": "Sensorineural Hearing Loss (SNHL)", "correct": false}, {"label": "C", "text": "Presbycusis", "correct": false}, {"label": "D", "text": "Meniere’s Disease", "correct": false}], "correct_answer": "A. Conductive Hearing Loss", "question_images": ["https://image.prepladder.com/notes/yqV5HI5etv7FE0g9ZBW81741765927.png"], "explanation_images": ["https://image.prepladder.com/content/idpGi3efabcRZYtHSfAI1738822948.png", "https://image.prepladder.com/content/XNovRtsHow7LlhJOmb5p1738822974.png", "https://image.prepladder.com/content/Ssn9nKts45mbGtVo6xlp1738823022.png", "https://image.prepladder.com/content/oLR2WrplTA2sahG0p2Tq1738823051.png", "https://image.prepladder.com/content/flQkDVM5eQ5b6UDWyX491738823072.png", "https://image.prepladder.com/content/FE3UDspu8JRKtWoWpvyz1738823118.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:562px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Air Conduction (AC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bone Conduction (BC)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>125 - 8000 Hz</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>250 - 4000 Hz</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indicates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overall hearing sensitivity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cochlear function</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Ear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Both AC and BC thresholds are within the <span class=\"customMeta\" data-dictid=\"f3ae79c18b1692777193468a9fd567\">normal range</span> (Within 20db in all frequencies)</li>\n<li>No significant A-B gap</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/XNovRtsHow7LlhJOmb5p1738822974.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conductive Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>AC Thresholds:</strong> Elevated (poorer hearing) compared to normal.</li>\n<li><strong>BC Thresholds:</strong> Within normal limits.</li>\n<li><strong>A-B Gap (&gt;20db):</strong> Significant</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/Ssn9nKts45mbGtVo6xlp1738823022.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensorineural Hearing Loss (SNHL)</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>AC Thresholds:</strong> Elevated</li>\n<li><strong>BC Thresholds:</strong> Elevated to the same degree as AC.</li>\n<li><strong>A-B Gap:</strong> Minimal or absent</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/oLR2WrplTA2sahG0p2Tq1738823051.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presbycusis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>AC Thresholds:</strong> Elevated, particularly in high frequencies.</li>\n<li><strong>BC Thresholds:</strong> Elevated with greater loss in higher frequencies.</li>\n<li><strong>A-B Gap:</strong> Minimal</li>\n<li><strong>Downsloping</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/flQkDVM5eQ5b6UDWyX491738823072.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meniere’s Disease</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Upsloping</strong></li>\n<li><strong>A-B Gap:</strong> Typically minimal</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"790\" src=\"https://image.prepladder.com/content/FE3UDspu8JRKtWoWpvyz1738823118.png\" width=\"795\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0kbGGNiFWCZsmeXzh51t1741685669.mp3", "video": ""}, {"text": "A 60-year-old patient is being evaluated for hearing loss using various tuning fork tests. What are the expected findings for a patient with sensorineural hearing loss (SNHL)?", "options": [{"label": "A", "text": "Rinne: Positive; Weber: Affected ear; Bing: louder", "correct": false}, {"label": "B", "text": "Rinne: Positive ; Weber: Better ear ; Schwabach: Shorter", "correct": true}, {"label": "C", "text": "Rinne: Negative; Schwabach: Longer; Gelle’s: No change.", "correct": false}, {"label": "D", "text": "ABC: Same; Weber: Unaffected ear; Bing: No change with occlusion.", "correct": false}], "correct_answer": "B. Rinne: Positive ; Weber: Better ear ; Schwabach: Shorter", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Conductive Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Sensorineural Hearing Loss</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Rinne Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>BC &gt; AC (negative)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>AC &gt; BC (positive)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Weber Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Lateralises to the affected ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Lateralises to the unaffected ear</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>ABC Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Same duration as the examiner</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Shorter duration than the examiner</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Schwabach Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Longer duration than the examiner</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Shorter duration than the examiner</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Bing Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>No change with <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> (negative)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Louder with <span class=\"customMeta\" data-dictid=\"896c5469811692777194e64e7ccef7\">occlusion</span> (positive)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p><strong>Gelle’s Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>No change with pressure (negative)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p>Decreased hearing with increased pressure (positive)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zOAl0guuDspqjV0SWczX1745603842.mp3", "video": ""}, {"text": "Which of the following is the correct sequence of structures involved in the transmission of sound from the external environment?", "options": [{"label": "A", "text": "Pinna → Tympanic membrane → Ossicles → Basilar membrane → Organ of Corti → Auditory nerve", "correct": true}, {"label": "B", "text": "Tympanic membrane → Pinna → Ossicles → Cochlea → Auditory nerve → Organ of Corti", "correct": false}, {"label": "C", "text": "Ossicles → Pinna → Tympanic membrane → Organ of Corti → Cochlea → Basilar membrane", "correct": false}, {"label": "D", "text": "Pinna → Cochlea → Ossicles → Tympanic membrane → Auditory nerve → Basilar membrane", "correct": false}], "correct_answer": "A. Pinna → Tympanic membrane → Ossicles → Basilar membrane → Organ of Corti → Auditory nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EyiP5odutQCJJ5blTBsE1738822331.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sClDjKz3ca687wPypOQi1741678228.mp3", "video": ""}, {"text": "A 55-year-old patient with sensorineural hearing loss (SNHL) undergoes hearing tests. The examiner performs the Absolute Bone Conduction (ABC) Test and the Schwabach Test. What are the expected findings of the duration of both tests?", "options": [{"label": "A", "text": "Both are Longer", "correct": false}, {"label": "B", "text": "Both are Shorter", "correct": true}, {"label": "C", "text": "ABC - Longer, Schwabach - Shorter", "correct": false}, {"label": "D", "text": "ABC - Shorter, Schwabach - Same as Examiner", "correct": false}], "correct_answer": "B. Both are Shorter", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZcYnDZZTsUoOtBSYzdhN1741765479.mp3", "video": ""}, {"text": "A 50-year-old patient presents with hearing loss. On examination, the Weber test indicates that the vibrations are lateralised to the left ear. Given the Weber test findings, which of the following conditions could explain these findings?", "options": [{"label": "A", "text": "Conductive hearing loss in the left ear", "correct": true}, {"label": "B", "text": "Sensorineural hearing loss in the left ear", "correct": false}, {"label": "C", "text": "Conductive hearing loss in the right ear", "correct": false}, {"label": "D", "text": "Normal hearing in the left ear", "correct": false}], "correct_answer": "A. Conductive hearing loss in the left ear", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4KnS6Ml8BQ1xdtbOM6311738822864.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:635px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Result</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reason</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conductive <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">Hearing Loss</span> (CHL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sound lateralises to the affected ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In CHL, sound conducted through bone is perceived louder in the ear with impaired <span class=\"customMeta\" data-dictid=\"c6b732e83416927771812e15b4586c\">air conduction</span> due to decreased <span class=\"customMeta\" data-dictid=\"d3495799cb16927771819a4eab9793\">ambient</span> noise.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensorineural <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">Hearing Loss</span> (SNHL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sound lateralises to the unaffected (better) ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In SNHL, the sound is perceived to be louder in the ear with better cochlear function, as the affected ear struggles with both air-conducted and bone-conducted sounds.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DTuKLtOIe54cr6YNatqH1741764992.mp3", "video": ""}, {"text": "A 55-year-old patient presents with hearing difficulties. During the Rinne test, bone conduction (BC) is significantly better than air conduction (AC) in the right ear. The Weber test shows lateralisation to the right ear. What is the most likely cause of these findings?", "options": [{"label": "A", "text": "Sensorineural hearing loss in the left ear", "correct": false}, {"label": "B", "text": "Conductive hearing loss in the right ear", "correct": true}, {"label": "C", "text": "Conductive hearing loss in the left ear", "correct": false}, {"label": "D", "text": "Mixed hearing loss in the right ear", "correct": false}], "correct_answer": "B. Conductive hearing loss in the right ear", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conductive Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensorineural Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Hearing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>How to Perform</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rinne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative (BC &gt; AC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (AC &gt; BC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (AC &gt; BC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Place the vibrating <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> bone (BC). When sound is no longer heard, move it near the ear <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> (AC).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weber</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateralises to worse ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateralises to better ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heard equally</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Place the vibrating <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> on the midline of the forehead or the top of the head.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Bone Conduction</strong></p>\n<p><strong>(ABC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears as long as the examiner</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears for a shorter duration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears as long as the examiner</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both the patient's and examiner’s ear canals are occluded. Place the vibrating <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> bone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schwabach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lengthened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Place the vibrating <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> bone. Compare the duration the patient hears the sound with the examiner’s hearing duration.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BOHnQTodDL3jYe0neyfz1741764704.mp3", "video": ""}, {"text": "A 60-year-old woman with suspected conductive hearing loss undergoes a Rinne test using different tuning forks. The test reveals a better perception of sound through bone conduction compared to air conduction. Which tuning fork frequency is most likely used in this test?", "options": [{"label": "A", "text": "256 Hz", "correct": false}, {"label": "B", "text": "512 Hz", "correct": true}, {"label": "C", "text": "1024 Hz", "correct": false}, {"label": "D", "text": "2048 Hz", "correct": false}], "correct_answer": "B. 512 Hz", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tuning Fork Test Result</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Predicted <span class=\"customMeta\" data-dictid=\"c8b08b1714169277718140870161dd\">Air-Bone Gap</span> (dB)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rinne test equal/negative for 256 Hz, positive for 512 Hz</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-30 dB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rinne test negative for 256 Hz and 512 Hz, positive for 1024 Hz</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-45 dB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rinne test negative for 256 Hz, 512 Hz, and 1024 Hz</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>45-60 dB</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nbtMwluMZNEWDGWdPPvK1741764490.mp3", "video": ""}, {"text": "The image given below of the auditory pathway, depicts auditory signals travelling from the cochlea to the primary auditory cortex and passes through the following structures in sequences A, B, C, and D. Which sequence correctly identifies the order of these structures?", "options": [{"label": "A", "text": "A - Cochlear Nucleus; B - Superior Olivary Complex; C - Inferior Colliculus; D - Medial Geniculate Nucleus", "correct": true}, {"label": "B", "text": "A - Medial Geniculate Nucleus; B - Cochlear Nucleus; C - Inferior Colliculus; D - Superior Olivary Complex", "correct": false}, {"label": "C", "text": "A - Inferior Colliculus; B - Cochlear Nucleus; C - Medial Geniculate Nucleus; D - Superior Olivary Complex", "correct": false}, {"label": "D", "text": "A - Superior Olivary Complex; B - Medial Geniculate Nucleus; C - Cochlear Nucleus; D - Inferior Colliculus", "correct": false}], "correct_answer": "A. A - Cochlear Nucleus; B - Superior Olivary Complex; C - Inferior Colliculus; D - Medial Geniculate Nucleus", "question_images": ["https://image.prepladder.com/content/LdaSAZEwWI4bc41hKZW31738822675.png"], "explanation_images": ["https://image.prepladder.com/content/YZTVKqFJKR96L65qPWn41738822728.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FUI3yMmkBdnaltLBy00f1741763927.mp3", "video": ""}, {"text": "A 40-year-old male presents with difficulty localising sounds and a reduced ability to discern speech in noisy environments. He reports no significant hearing loss. Imaging studies reveal normal cochlear and auditory nerve structures, but a lesion is detected in the brainstem. Which structure in the auditory pathway is most likely affected?", "options": [{"label": "A", "text": "cochlea", "correct": false}, {"label": "B", "text": "auditory cortex", "correct": false}, {"label": "C", "text": "Superior olivary complex", "correct": true}, {"label": "D", "text": "Medial geniculate body", "correct": false}], "correct_answer": "C. Superior olivary complex", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HEJ6heLg1qEPgcKvvABn1738822620.png", "https://image.prepladder.com/content/BztFwTUM48Zk1eTZRljv1738822555.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Z7Y5ZLfC3xCW4qYW2FHf1741762784.mp3", "video": ""}, {"text": "Which of the following best describes the role of the phase difference between the oval and round windows in sound transmission?", "options": [{"label": "A", "text": "It amplifies sound waves by 10 dB", "correct": false}, {"label": "B", "text": "It prevents the cancellation of sound waves, allowing perilymph movement", "correct": true}, {"label": "C", "text": "It ensures simultaneous vibration of the oval and round windows", "correct": false}, {"label": "D", "text": "It decreases sound transmission efficiency, reducing hearing sensitivity by 4 dB", "correct": false}], "correct_answer": "B. It prevents the cancellation of sound waves, allowing perilymph movement", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/iK9G6uRtJNKfrgARug8Z1741755616.mp3", "video": ""}, {"text": "A 45-year-old man presents with progressive hearing loss in his right ear. Audiometry reveals sensorineural hearing loss, and an MRI shows no abnormalities in the cochlear nerve. A defect in converting mechanical sound vibrations into electrical signals is suspected. Which of the following structures is most likely affected?", "options": [{"label": "A", "text": "Oval window", "correct": false}, {"label": "B", "text": "Organ of Corti", "correct": true}, {"label": "C", "text": "Tympanic membrane", "correct": false}, {"label": "D", "text": "Stapes footplate", "correct": false}], "correct_answer": "B. Organ of Corti", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/fiVnEo99MMad0GGwwWMi1738822392.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WWpA8S93rZqcU9LoJ7iT1746289385.mp3", "video": ""}, {"text": "What is the total amplification of sound in the auditory system due to impedance matching, considering both the lever action of the ossicles and the area ratio between the tympanic membrane and the oval window?", "options": [{"label": "A", "text": "1.3 times from lever action × 17 times from area ratio = 22.1 times", "correct": false}, {"label": "B", "text": "1.3 times from lever action × 20 times from area ratio = 26 times", "correct": false}, {"label": "C", "text": "1.5 times from lever action × 22 times from area ratio = 33 times", "correct": false}, {"label": "D", "text": "1.3 times from lever action × 14 times from area ratio = 18.2 times", "correct": true}], "correct_answer": "D. 1.3 times from lever action × 14 times from area ratio = 18.2 times", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:407px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Value</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Effective <span class=\"customMeta\" data-dictid=\"8df45d4d351692777202ac2dddb22e\">vibratory</span> area of TM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>45 mm²</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Footplate area</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3.2 mm²</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Areal ratio</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>14:1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lever ratio (ossicles)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.3:1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Total transformer ratio</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18.2:1 (approximately 18:1)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sfGoJWwJXvr3VQdTqBnf1741755196.mp3", "video": ""}, {"text": "Which of the following factors is most important in the impedance-matching mechanism of the auditory system, facilitating the transfer of sound from the air-filled middle ear to the fluid-filled cochlea?", "options": [{"label": "A", "text": "Acoustic Reflex of the Middle Ear Muscles", "correct": false}, {"label": "B", "text": "Area ratio between the tympanic membrane and the oval window", "correct": true}, {"label": "C", "text": "Lever action of the malleus and stapes", "correct": false}, {"label": "D", "text": "Resonance of the basilar membrane", "correct": false}], "correct_answer": "B. Area ratio between the tympanic membrane and the oval window", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lever Action of the Ossicles </strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <strong>malleus</strong> has a longer handle compared to the <strong>incus</strong>, forming a lever system.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amplifies vibrations from the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> to the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> by a factor of 1.3.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hydraulic Action of the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">Tympanic</span> Membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> is larger than the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate, with an area ratio of about 21:1, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> to 14:1 due to functional area.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Concentrates force at the smaller <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate, significantly increasing sound pressure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Curved <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> is slightly conical, causing greater vibrations at the <span class=\"customMeta\" data-dictid=\"316866040e1692777195f45393e010\">periphery</span> than at the centre.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases the force applied to the ossicles, enhancing sound energy transmission.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qJrKoMvuwqUPiz7H6rdj1741679020.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 33 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 112 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "What is the interpretation of the following PTA conducted on a patient?", "options": [{"label": "A", "text": "Mixed hearing loss", "correct": true}, {"label": "B", "text": "Sensorineural hearing loss", "correct": false}, {"label": "C", "text": "Conductive hearing loss", "correct": false}, {"label": "D", "text": "Normal", "correct": false}], "correct_answer": "A. Mixed hearing loss", "question_images": ["https://image.prepladder.com/content/dl4eLsSEOSUFUiVNfbCR1741772451.png"], "explanation_images": ["https://image.prepladder.com/content/VvrsCC5gyU2wkWCMnwQK1741772472.png", "https://image.prepladder.com/content/0ZONL5WHSYeeQYCQDCm21741772494.png", "https://image.prepladder.com/content/GDG0OFZ1QXKwxBf0tN1q1741271141.png", "https://image.prepladder.com/content/dMrd0WhqAu0ktEZB0hqB1741271194.png", "https://image.prepladder.com/content/0CCmAl21sKkKTlfVcCJ11741271238.png", "https://image.prepladder.com/content/wn6ewKRPYaxJ1DxYKWCV1741271272.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:562px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Air <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> (AC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> (BC)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>125 - 8000 Hz</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>250 - 4000 Hz</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indicates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Overall hearing sensitivity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cochlear function</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:352px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Ear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Both AC and BC thresholds are within the <span class=\"customMeta\" data-dictid=\"f3ae79c18b1692777193468a9fd567\">normal range</span> (Within 20db in all frequencies)</li>\n<li>No significant A-B gap</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/0ZONL5WHSYeeQYCQDCm21741772494.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conductive Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>AC Thresholds:</strong> Elevated (poorer hearing) compared to normal.</li>\n<li><strong>BC Thresholds:</strong> Within normal limits.</li>\n<li><strong>A-B Gap (&gt;20db):</strong> Significant</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/GDG0OFZ1QXKwxBf0tN1q1741271141.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensorineural <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">Hearing Loss</span> (SNHL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>AC Thresholds:</strong> Elevated</li>\n<li><strong>BC Thresholds:</strong> Elevated to the same degree as AC.</li>\n<li><strong>A-B Gap:</strong> Minimal or absent</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/dMrd0WhqAu0ktEZB0hqB1741271194.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presbycusis</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>AC Thresholds:</strong> Elevated, particularly in high frequencies.</li>\n<li><strong>BC Thresholds:</strong> Elevated with greater loss in higher frequencies.</li>\n<li><strong>A-B Gap:</strong> Minimal</li>\n<li><strong>Downsloping</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/0CCmAl21sKkKTlfVcCJ11741271238.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meniere’s Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Upsloping</strong></li>\n<li><strong>A-B Gap:</strong> Typically minimal</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"464\" src=\"https://image.prepladder.com/content/wn6ewKRPYaxJ1DxYKWCV1741271272.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Carhart's notch is seen in which of the following conditions:", "options": [{"label": "A", "text": "Otosclerosis", "correct": true}, {"label": "B", "text": "Ossicular Discontinuity", "correct": false}, {"label": "C", "text": "Oto syphilis", "correct": false}, {"label": "D", "text": "Serous otitis media", "correct": false}], "correct_answer": "A. Otosclerosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ohpsW17nyBe42ajVLW081741271575.png", "https://image.prepladder.com/content/VTfP8dcoFcWZjAjgvXJw1741271550.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:690px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Otosclerosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Noise-Induced <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">Hearing Loss</span> (NIHL)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Air Conduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss, more pronounced at lower frequencies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> and Characteristic pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal, may show <strong>\"Carhart's notch\"</strong> at 2000 Hz (5-15 dB loss)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typical <span class=\"customMeta\" data-dictid=\"80dc1890d11692777193322fc863b1\">notch</span> at 4000 Hz in both air and <span class=\"customMeta\" data-dictid=\"b295cd96751692777183939f64ff6e\">bone conduction</span> <strong>(Boiler's notch)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensorineural</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/ohpsW17nyBe42ajVLW081741271575.png\" width=\"1999\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/VTfP8dcoFcWZjAjgvXJw1741271550.png\" width=\"1999\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following causes maximum hearing loss:", "options": [{"label": "A", "text": "Serous otitis media", "correct": false}, {"label": "B", "text": "Disrupted ossicular chain with intact tympanic membrane", "correct": true}, {"label": "C", "text": "Disrupted ossicular chain and disrupted tympanic membrane", "correct": false}, {"label": "D", "text": "Partial footplate fixation", "correct": false}], "correct_answer": "B. Disrupted ossicular chain with intact tympanic membrane", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common hearing test done in neonates for screening:", "options": [{"label": "A", "text": "Clap &amp;amp; smile", "correct": false}, {"label": "B", "text": "BERA", "correct": false}, {"label": "C", "text": "OAE", "correct": true}, {"label": "D", "text": "PTA", "correct": false}], "correct_answer": "C. OAE", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UZ4T9PVSnNvXoVTzNcqm1741772668.png", "https://image.prepladder.com/content/hLceJVrhFrYOwaJn5lgo1741271950.png", "https://image.prepladder.com/content/CRq0dTT063aDpRjXSqed1741272003.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which procedure is shown in the following diagram?", "options": [{"label": "A", "text": "Stapedotomy", "correct": true}, {"label": "B", "text": "Myringotomy", "correct": false}, {"label": "C", "text": "Myringoplasty", "correct": false}, {"label": "D", "text": "Tympanoplasty", "correct": false}], "correct_answer": "A. Stapedotomy", "question_images": ["https://image.prepladder.com/content/sFL23HhlWm05I3knStzZ1741772729.png"], "explanation_images": ["https://image.prepladder.com/content/LtNEh1J6UMAuLYgStLYZ1741772744.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A small opening made in the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate; a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> is inserted.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> rates; preferred by many otologists.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete removal of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> bone; replaced with a <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> device.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of complications.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 49-year-old female from Nagaland presented with right-sided hearing loss and tinnitus. On examination, dull tympanic membrane with lymph nodes in the posterior triangle of the neck was seen. Which of the following is the management for the condition?", "options": [{"label": "A", "text": "Grommet insertion + Steroids", "correct": false}, {"label": "B", "text": "Grommet insertion", "correct": false}, {"label": "C", "text": "Steroids", "correct": false}, {"label": "D", "text": "Radiotherapy", "correct": true}], "correct_answer": "D. Radiotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 9-month-old baby was admitted in the ICU with history of recurrent sinusitis and otitis media by staph aureus. Laboratory examination showed decreased serum IgA, IgG, IgM, IgE, and plasma B cells. Which of the following is the condition is described here?", "options": [{"label": "A", "text": "Ataxia telangiectasia", "correct": false}, {"label": "B", "text": "Chronic granulomatosis disease", "correct": false}, {"label": "C", "text": "Bruton syndrome", "correct": true}, {"label": "D", "text": "Di George syndrome", "correct": false}], "correct_answer": "C. Bruton syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD with hearing loss. On examination: Rinne test- Positive in the left ear and negative in the right ear Weber's test - lateralization towards the left Bone conduction test - Reduced in the right ear and similar in the left ear. Interpret the findings.", "options": [{"label": "A", "text": "Sensorineural hearing loss in left ear", "correct": false}, {"label": "B", "text": "Sensorineural hearing loss in right ear", "correct": true}, {"label": "C", "text": "Conductive hearing loss in left ear", "correct": false}, {"label": "D", "text": "Conductive hearing loss in right ear.", "correct": false}], "correct_answer": "B. Sensorineural hearing loss in right ear", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:473px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conductive Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensorineural Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal Hearing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rinne</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Negative (BC &gt; AC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (AC &gt; BC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive (AC &gt; BC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Weber</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateralises to worse ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateralises to better ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heard equally</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Bone Conduction</strong></p>\n<p><strong>(ABC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears as long as the examiner</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears for a shorter duration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hears as long as the examiner</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schwabach</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lengthened</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduced</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with CSOM was presented to the OPD with seizures. On examination and evaluation, homonymous hemianopia and epilepsy were present. Identify the condition with the CT scan given below?", "options": [{"label": "A", "text": "Temporal abscess", "correct": true}, {"label": "B", "text": "Cerebellar abscess", "correct": false}, {"label": "C", "text": "Extradural abscess", "correct": false}, {"label": "D", "text": "Meningitis", "correct": false}], "correct_answer": "A. Temporal abscess", "question_images": ["https://image.prepladder.com/content/jojksr3JpyU3ptperaiM1741063106.png"], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sign given in the image below:", "options": [{"label": "A", "text": "Beta 2 transferrin sign", "correct": false}, {"label": "B", "text": "Double target sign", "correct": true}, {"label": "C", "text": "Handkerchief sign", "correct": false}, {"label": "D", "text": "Tear drop sign", "correct": false}], "correct_answer": "B. Double target sign", "question_images": ["https://image.prepladder.com/content/ZaPwSORmz8zWcsfNDJfK1741087152.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the treatment option with the image given below:", "options": [{"label": "A", "text": "Type 1 Tympanoplasty", "correct": false}, {"label": "B", "text": "Type 2 tympanoplasty", "correct": false}, {"label": "C", "text": "Type 3 tympanoplasty", "correct": true}, {"label": "D", "text": "Type 4 tympanoplasty", "correct": false}], "correct_answer": "C. Type 3 tympanoplasty", "question_images": ["https://image.prepladder.com/content/AS0HT1SHGyfwWT28CNES1747846067.png"], "explanation_images": ["https://image.prepladder.com/content/3fYknAREzgQf0ThAQFjZ1747846131.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n<p>Repaired using a graft. (myringoplasty) <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Eroded <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n<p>Graft placed on <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> or remaining malleus. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Absence of <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and incus.</p>\n<p>Graft placed directly on <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> head (myringostapediopexy or <span class=\"customMeta\" data-dictid=\"e03b2f95ab1692777184437bf8f3c5\">columella</span> tympanoplasty).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Defect: Only the <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> is present. It is exposed to the external ear.</p>\n<p>A <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> is placed between <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> and round windows, allowing sound to act directly on the <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> and the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> is shielded. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fenestration operation: Creation of a new window on the <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> semicircular canal, covering it with a <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> when the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> is fixed but the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> is functional.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman is diagnosed with right vestibular neuronitis. What findings are expected during the head impulse test in this patient?", "options": [{"label": "A", "text": "When the head is turned to the left, the eyeballs move to the left with nystagmus.", "correct": false}, {"label": "B", "text": "When the head is turned to the left, the eyeballs move to the right with nystagmus.", "correct": false}, {"label": "C", "text": "When the head is turned to the right, the eyeballs move to the left with nystagmus.", "correct": true}, {"label": "D", "text": "When the head is turned to the right, the eyeballs move to the right with nystagmus.", "correct": false}], "correct_answer": "C. When the head is turned to the right, the eyeballs move to the left with nystagmus.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/w1Dd85kPawoLtEv9nt7o1724840783.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a history of ear discharge. On examination, a small perforation is observed in the antero-inferior segment of the tympanic membrane. What is the most likely result of Rinne’s test?", "options": [{"label": "A", "text": "Rinne’s positive", "correct": false}, {"label": "B", "text": "Rinne’s negative", "correct": true}, {"label": "C", "text": "Rinne’s equivocal", "correct": false}, {"label": "D", "text": "Cannot be determined", "correct": false}], "correct_answer": "B. Rinne’s negative", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Rinne’s negativ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: 1 Greater auricular nerve 2 Auriculotemporal nerve 3 Auricular branch of the vagus nerve 4 Lesser occipital nerve", "options": [{"label": "A", "text": "1-D, 2-C, 3-A, 4-B", "correct": false}, {"label": "B", "text": "1-C, 2-A, 3-B, 4-D", "correct": true}, {"label": "C", "text": "1-C, 2-B, 3-A, 4-D", "correct": false}, {"label": "D", "text": "1-D, 2-A, 3-B, 4-C", "correct": false}], "correct_answer": "B. 1-C, 2-A, 3-B, 4-D", "question_images": ["https://image.prepladder.com/content/qAy7WFuikz9RPNTNlVqy1724847173.png"], "explanation_images": ["https://image.prepladder.com/content/3kWhXSobVjidhRNRwoQa1724847266.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient’s Pure Tone Audiometry (PTA) findings reveal a Carhart's notch. Which of the following is most likely associated with this finding?", "options": [{"label": "A", "text": "Schwartz sign", "correct": true}, {"label": "B", "text": "Hitzelberger sign", "correct": false}, {"label": "C", "text": "Henebert sign", "correct": false}, {"label": "D", "text": "Aquinos Sign", "correct": false}], "correct_answer": "A. Schwartz sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GWdP1IxrvBX7qb87Vuip1724839388.png"], "explanation": "<p>Correct Option A - Schwartz sig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman presents with a gradually progressive hearing loss in her right ear, accompanied by pulsatile tinnitus. On otoscopic examination, a red vascular mass is seen behind the tympanic membrane. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Cholesteatoma", "correct": false}, {"label": "B", "text": "Glomus Tympanicum", "correct": true}, {"label": "C", "text": "Acoustic Neuroma", "correct": false}, {"label": "D", "text": "Otosclerosis", "correct": false}], "correct_answer": "B. Glomus Tympanicum", "question_images": ["https://image.prepladder.com/content/j0oQZ0AisMT94ke6RVTL1724908951.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Glomus Tympanicu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An audiogram of a 30-year-old female is given. What is the diagnosis?", "options": [{"label": "A", "text": "Otosclerosis", "correct": true}, {"label": "B", "text": "Meniers disease", "correct": false}, {"label": "C", "text": "Noise-induced hearing loss", "correct": false}, {"label": "D", "text": "Presbycusis", "correct": false}], "correct_answer": "A. Otosclerosis", "question_images": ["https://image.prepladder.com/content/eYwG7ygBeyQrQiDfECpy1747294993.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presented with vertigo, tinnitus and hearing loss. The audiogram is given below. What is the most likely diagnosis based on the given image?", "options": [{"label": "A", "text": "BPPV", "correct": false}, {"label": "B", "text": "Meniers disease", "correct": true}, {"label": "C", "text": "Vestibular neuronitis", "correct": false}, {"label": "D", "text": "Presbycusis", "correct": false}], "correct_answer": "B. Meniers disease", "question_images": ["https://image.prepladder.com/content/3IoaHKR64JVwEi0BuYS11747295086.png"], "explanation_images": ["https://image.prepladder.com/content/eSoSSUcNZoo9688kJKPC1747295141.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with repeated infections from the lesion shown in the image. The correct statement in relation to the image?", "options": [{"label": "A", "text": "Derived from ectoderm of 1st and 2nd arch", "correct": true}, {"label": "B", "text": "Derived from the pouch of 1st and 2nd arch", "correct": false}, {"label": "C", "text": "Derived from mesoderm of 1st and 2nd arch", "correct": false}, {"label": "D", "text": "Derived from ectoderm of 3rd and 4th arch", "correct": false}], "correct_answer": "A. Derived from ectoderm of 1st and 2nd arch", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient with ear pain and an HBA1c of 10 presents with excruciating ear pain and blood-stained ear discharge. What is the most likely diagnosis in this patient?", "options": [{"label": "A", "text": "Otitis externa", "correct": false}, {"label": "B", "text": "Necrotizing otitis externa", "correct": true}, {"label": "C", "text": "Serous otitis media", "correct": false}, {"label": "D", "text": "Otomycosis", "correct": false}], "correct_answer": "B. Necrotizing otitis externa", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man came to the OPD with complaints of pain and hearing loss after trauma to the right ear. Examination revealed the presence of blood clots along with irregular perforations in the tympanic membrane. The next step in management is?", "options": [{"label": "A", "text": "Aspirate the clot and perform audiometric tests", "correct": false}, {"label": "B", "text": "Syringing", "correct": false}, {"label": "C", "text": "Maintain dry ear with systemic analgesics", "correct": true}, {"label": "D", "text": "Gentamycin and levofloxacin ear drops", "correct": false}], "correct_answer": "C. Maintain dry ear with systemic analgesics", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Tear or <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (eardrum) due to trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct trauma (e.g., cotton bud, foreign body)</li>\n<li>Barotrauma (e.g., diving, blast injury, airplane pressure changes)</li>\n<li>Slap/blow to the ear</li>\n<li>Sudden loud noise (acoustic trauma)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden ear pain</li>\n<li>Hearing loss (usually conductive)</li>\n<li>Tinnitus</li>\n<li>Bleeding or clear <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> from ear</li>\n<li>Vertigo (if <span class=\"customMeta\" data-dictid=\"a1b8deb0fe1692777190df5ce46525\">inner ear</span> involved)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Visible <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> on otoscopy</li>\n<li>Blood/debris in the ear canal</li>\n<li>Possible absent light reflex</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Otoscopy (main <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> tool)</li>\n<li>Tuning fork tests (Rinne/Weber for <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> type)</li>\n<li>Audiometry (after <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> or in unclear cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Keep ear dry (avoid water entry)</li>\n<li>Most heal spontaneously within weeks</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"d9cbcf920216927771861532afed31\">ear drops</span> unless infection suspected</li>\n<li>Antibiotics if contaminated or signs of infection</li>\n<li>Surgical repair (myringoplasty) if not healed in 6–8 weeks</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following image shows which X-ray view?", "options": [{"label": "A", "text": "Waters view", "correct": false}, {"label": "B", "text": "Caldwell's view", "correct": false}, {"label": "C", "text": "Towne view", "correct": true}, {"label": "D", "text": "Hirtz view", "correct": false}], "correct_answer": "C. Towne view", "question_images": ["https://image.prepladder.com/content/tRqusJeXGA20dY1xR2eM1747303518.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following interventions should not be done in an 8-year-old boy with bilateral sensorineural hearing loss?", "options": [{"label": "A", "text": "Preferential sitting in the classroom", "correct": false}, {"label": "B", "text": "Adenoidectomy with grommet insertion", "correct": true}, {"label": "C", "text": "Hearing aid", "correct": false}, {"label": "D", "text": "Cochlear implant", "correct": false}], "correct_answer": "B. Adenoidectomy with grommet insertion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4606b784281692777180cad55735b5\"&gt;Adenoidectomy&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"efcdc8d2f71692777188341ac61941\"&gt;grommet&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following signs is not associated with otitis media with effusion?", "options": [{"label": "A", "text": "Mostly bilateral", "correct": false}, {"label": "B", "text": "AD curve on tympanometry with conductive hearing loss", "correct": true}, {"label": "C", "text": "Adenoid hypertrophy is cause of SOM", "correct": false}, {"label": "D", "text": "Mostly resolves on its own", "correct": false}], "correct_answer": "B. AD curve on tympanometry with conductive hearing loss", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/a75HYLEYU3wNiuv7Uheq1717755391.png"], "explanation": "<p>Correct Option B - AD curve on &lt;span class=\"customMeta\" data-dictid=\"2e18cb4dff16927772010064616fed\"&gt;tympanometry&lt;/span&gt; with conductive hearing\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most commonly used test for newborn hearing screening?", "options": [{"label": "A", "text": "Otoacoustic Emissions (OAE)", "correct": true}, {"label": "B", "text": "Brainstem Evoked Response Audiometry (BERA)", "correct": false}, {"label": "C", "text": "Pure Tone Audiometry (PTA)", "correct": false}, {"label": "D", "text": "Tympanometry", "correct": false}], "correct_answer": "A. Otoacoustic Emissions (OAE)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of trauma presents with hearing loss. A High-Resolution Computed Tomography (HRCT) scan was performed. Which of the following structures is not typically visualized on HRCT?", "options": [{"label": "A", "text": "Cochlea", "correct": false}, {"label": "B", "text": "Vestibule", "correct": false}, {"label": "C", "text": "Semicircular canal", "correct": false}, {"label": "D", "text": "Organ of Corti", "correct": true}], "correct_answer": "D. Organ of Corti", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are symptoms of Gradenigo syndrome?", "options": [{"label": "A", "text": "Ear discharge, retro-orbital pain, and diplopia", "correct": true}, {"label": "B", "text": "Nasal discharge, retro-orbital pain, and diplopia", "correct": false}, {"label": "C", "text": "Ear discharge, retro-orbital pain, and headache", "correct": false}, {"label": "D", "text": "Retro-orbital pain, Diplopia, and hearing loss", "correct": false}], "correct_answer": "A. Ear discharge, retro-orbital pain, and diplopia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures is responsible for balance and hearing?", "options": [{"label": "A", "text": "Semicircular canal", "correct": false}, {"label": "B", "text": "Cochlea", "correct": false}, {"label": "C", "text": "Vestibule", "correct": true}, {"label": "D", "text": "Organ of Corti", "correct": false}], "correct_answer": "C. Vestibule", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with progressive hearing loss that has been worsening over the past few years. Audiometry confirms conductive hearing loss, and a diagnosis of otosclerosis is made. What is the surgical treatment of choice for her condition?", "options": [{"label": "A", "text": "Stapedectomy with the placement of a prosthesis", "correct": true}, {"label": "B", "text": "Stapedotomy", "correct": false}, {"label": "C", "text": "Stapes mobilization", "correct": false}, {"label": "D", "text": "Lemperts Fenestration operation", "correct": false}], "correct_answer": "A. Stapedectomy with the placement of a prosthesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small opening made in the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate; a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> is inserted.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> rates; preferred by many otologists.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete removal of the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> bone; replaced with a <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> device.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher risk of complications.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures contain Ostmann fat pad?", "options": [{"label": "A", "text": "Ear lobule", "correct": false}, {"label": "B", "text": "Tip of nose", "correct": false}, {"label": "C", "text": "Eustachian tube", "correct": true}, {"label": "D", "text": "Buccal mucosa", "correct": false}], "correct_answer": "C. Eustachian tube", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman with deafness presents for evaluation and is diagnosed with 50dB hearing loss. Which of the following structures is most likely responsible for this hearing loss?", "options": [{"label": "A", "text": "Ossicular fixation with an intact tympanic membrane", "correct": true}, {"label": "B", "text": "Ossicular fixation with a damaged tympanic membrane", "correct": false}, {"label": "C", "text": "Erosion with tympanic membrane injury", "correct": false}, {"label": "D", "text": "Erosion without tympanic membrane injury", "correct": false}], "correct_answer": "A. Ossicular fixation with an intact tympanic membrane", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xeIKTH9sXqcTByROdQEq1747372922.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the accurate sequence of the auditory pathway.", "options": [{"label": "A", "text": "Eight nerve → cochlear nuclei → superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex", "correct": true}, {"label": "B", "text": "Eight nerve →Cochlear nuclei → lateral lemniscus → superior olivary nucleus → inferior colliculus → medial geniculate body → auditory cortex", "correct": false}, {"label": "C", "text": "Eight nerve →Superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex → Cochlear nuclei", "correct": false}, {"label": "D", "text": "Eight nerve →Superior olivary nucleus → inferior colliculus → medial geniculate body → auditory cortex → Cochlear nuclei → lateral lemniscus", "correct": false}], "correct_answer": "A. Eight nerve → cochlear nuclei → superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate body → auditory cortex", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TagwKcV35lz5HfWYJTr41745998103.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 64-year-old female patient is brought to the ENT OPD with difficulties in comprehension. On examination, her fluency is found to be intact with poor comprehension and repetition. Her Pure tone audiometry and ABR is normal. What is the likely diagnosis in this patient?", "options": [{"label": "A", "text": "Malingering", "correct": false}, {"label": "B", "text": "Auditory cortex lesion", "correct": false}, {"label": "C", "text": "Broca's aphasia", "correct": false}, {"label": "D", "text": "Wernicke’s aphasia", "correct": true}], "correct_answer": "D. Wernicke’s aphasia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 2-year-old child with a sudden onset of noisy breathing, which type of stridor is most likely to be represented by the image below?", "options": [{"label": "A", "text": "Inspiratory", "correct": true}, {"label": "B", "text": "Expiratory", "correct": false}, {"label": "C", "text": "Biphasic", "correct": false}, {"label": "D", "text": "None of these", "correct": false}], "correct_answer": "A. Inspiratory", "question_images": ["https://image.prepladder.com/content/GoXjIrisuhVJ0KH3uFJu1692705841.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient with chronic sinusitis and nasal congestion, which anatomical structure is the most likely drainage pathway for the bulla ethmoidalis?", "options": [{"label": "A", "text": "Middle meatus", "correct": true}, {"label": "B", "text": "Superior meatus", "correct": false}, {"label": "C", "text": "Inferior meatus", "correct": false}, {"label": "D", "text": "Middle concha", "correct": false}], "correct_answer": "A. Middle meatus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Middle meatu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presenting with autophony, bilateral limb weakness and normal tympanic membrane that move with respiration. What is the probable cause of these symptoms?", "options": [{"label": "A", "text": "Meningioma", "correct": false}, {"label": "B", "text": "Multiple sclerosis", "correct": false}, {"label": "C", "text": "Weight loss", "correct": true}, {"label": "D", "text": "Wegener’s granulomatosis", "correct": false}], "correct_answer": "C. Weight loss", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Weight L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD with the complaints of vertigo which is sudden in onset, sensorineural hearing loss (SNHL), and tinnitus which lasts minutes to hours with accompanied nausea, vomiting and vagal symptoms. Investigations show there is endolymphatic hypertension present. What is the diagnosis of the patient?", "options": [{"label": "A", "text": "Meniere's Disease", "correct": true}, {"label": "B", "text": "Presbycusis", "correct": false}, {"label": "C", "text": "Benign Paroxysmal Positional Vertigo (BPPV)", "correct": false}, {"label": "D", "text": "Acoustic neuroma", "correct": false}], "correct_answer": "A. Meniere's Disease", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertigo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Episodic with sudden onset</strong></li>\n<li>Attacks occur in clusters, interspersed with periods of <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> accompanied by nausea, vomiting, <span class=\"customMeta\" data-dictid=\"0842a8a59f1692777182f44d334dda\">ataxia</span> &amp; nystagmus.</li>\n<li>Loud noises might trigger <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> due to the<strong> Tullio phenomenon.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Fluctuating</strong> <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> may improve between attacks but may progressively worsen over time, with some degree of permanent hearing loss.</li>\n<li>Sensorineural <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> initially affecting<strong> lower frequencies</strong>.</li>\n<li>Patients might experience distorted hearing or<strong> Diplacusis</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tinnitus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Low-pitched &amp; <span class=\"customMeta\" data-dictid=\"2499b2018a16927771978059423918\">Roaring</span> type</strong></li>\n<li>It can be aggravated during <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks and might persist during periods of remission</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aural Fullness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluctuates</strong> &amp; may vary in intensity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emotional Impact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> nature of symptoms can lead to emotional stress and <span class=\"customMeta\" data-dictid=\"c31ab816e01692777181649c694d46\">apprehension</span> about future attacks, contributing to overall distress.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD with complaints of bilateral hearing loss with worsened right ear hearing loss. He is diagnosed with otosclerosis and recommended stapedectomy as a final resort to the problem. What would be the findings of tuning fork tests on this patient?", "options": [{"label": "A", "text": "Rinne’s Test - positive; Weber’s Test - lateralized to left ear", "correct": false}, {"label": "B", "text": "Rinne’s Test - positive; Weber’s Test - lateralized to right ear", "correct": false}, {"label": "C", "text": "Rinne’s Test - negative; Weber’s Test - lateralized to left ear", "correct": false}, {"label": "D", "text": "Rinne’s Test - negative; Weber’s Test - lateralized to right ear", "correct": true}], "correct_answer": "D. Rinne’s Test - negative; Weber’s Test - lateralized to right ear", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BlwoWtFZtcjvXK5tJLei1744957092.png", "https://image.prepladder.com/content/vk7tEBBVHKlYhesZWRWB1744957117.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD with the complaint of hearing loss and can understand only shouting or amplified speech. What will be the degree of impairment according to the WHO classification of ability to understand speech?", "options": [{"label": "A", "text": "Mild hearing loss", "correct": false}, {"label": "B", "text": "Moderate hearing loss", "correct": false}, {"label": "C", "text": "Severe hearing loss", "correct": true}, {"label": "D", "text": "Profound hearing loss", "correct": false}], "correct_answer": "C. Severe hearing loss", "question_images": [], "explanation_images": [], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"text-align:center\"><strong>WHO grading of degree of hearing loss</strong></td>\n</tr>\n<tr>\n<td><strong>Degree of hearing loss </strong></td>\n<td><strong>Hearing threshold in better ear (average of 500, 1000 and 2000 Hz)</strong></td>\n</tr>\n<tr>\n<td>Not significant </td>\n<td>0-25 dB </td>\n</tr>\n<tr>\n<td>Mild </td>\n<td>26-30 dB</td>\n</tr>\n<tr>\n<td>Moderate </td>\n<td>41-55 dB </td>\n</tr>\n<tr>\n<td>Moderately severe </td>\n<td>56-70 dB </td>\n</tr>\n<tr>\n<td>Severe</td>\n<td>71-91 dB </td>\n</tr>\n<tr>\n<td>Profound </td>\n<td>Above 91 dB </td>\n</tr>\n<tr>\n<td>Total </td>\n<td> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mark the correct statement/ statements regarding Inner and Outer hair cells? I. Inner hair cells are in a single row and transmit auditory impulses. II. Outer hair cells are in 3-4 rows and modulate function of inner hair cells. III. Outer hair cells are more responsible for movement of Tectorial membrane. IV. · Outer and inner hair cells present in the ratio of 3:1.", "options": [{"label": "A", "text": "I, II and IV are correct", "correct": true}, {"label": "B", "text": "I, II and III are correct", "correct": false}, {"label": "C", "text": "All are correct", "correct": false}, {"label": "D", "text": "II, IV are correct", "correct": false}], "correct_answer": "A. I, II and IV are correct", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the examination of a female patient with hearing loss, it was observed that she had a negative Rinne test result at frequencies of 256 Hz and 512 Hz, but a positive Rinne test result at 1024 Hz. What would be the anticipated gap between air conduction and bone conduction in this case?", "options": [{"label": "A", "text": "30-45 dB", "correct": false}, {"label": "B", "text": "15-30 dB", "correct": true}, {"label": "C", "text": "45-60 dB", "correct": false}, {"label": "D", "text": "&amp;gt;60 dB", "correct": false}], "correct_answer": "B. 15-30 dB", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman came with complaints of hearing loss and pulsatile tinnitus. On examination, it is found that the patient has conductive hearing loss and the Rinne test results are negative. Additionally, a reddish mass is observed located behind the tympanic membrane. What is the likely diagnosis?", "options": [{"label": "A", "text": "Acute otitis media", "correct": false}, {"label": "B", "text": "Chronic otitis media", "correct": false}, {"label": "C", "text": "Glomus tumour", "correct": true}, {"label": "D", "text": "Serous otitis media", "correct": false}], "correct_answer": "C. Glomus tumour", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OiQycjRlOQwU67flWFxY1746423573.png", "https://image.prepladder.com/content/zpo7ZIJCZDsT1qLJbLuY1746423573.png", "https://image.prepladder.com/content/E5Ge6j6JKnyNzmj20JDH1746423573.png", "https://image.prepladder.com/content/bAYJMRPeBi05vNKPwaKR1746423573.png", "https://image.prepladder.com/content/1CFesPSUnfb5L3AR8oNi1746423573.png", "https://image.prepladder.com/content/I6abHj3LLf7Gdn5hWBNA1746423573.png", "https://image.prepladder.com/content/33xN8vCWohP6CbAxi1Tx1746423573.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:675px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Glomus tumor (Paraganglioma)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumors originating from the <span class=\"customMeta\" data-dictid=\"064aee539616927771943ff21f49fa\">paraganglia</span> are known as paragangliomas, with <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumors being a specific type of paraganglioma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumour type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benign (most common <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> tumor of middle ear)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paraganglionic cells or <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> bodies .</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Commonly seen in middle-aged individuals (40-50 years), with a higher <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Glomus tympanicum:</strong> Arise from the <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> of the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> (tympanic plexus).</li>\n<li><strong>Glomus jugulare: </strong>Arises from the <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb (sympathetic <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> covering the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein).<strong> </strong></li>\n</ol>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"228\" src=\"https://image.prepladder.com/content/OiQycjRlOQwU67flWFxY1746423573.png\" width=\"324\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spread </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inferiorly: </strong>To the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> foramen</li>\n<li><strong>Anteriorly: </strong>Invading into the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> (blockage of <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube)</li>\n<li><strong>Posteriorly: </strong>Invading the mastoid</li>\n<li><strong>Superiorly: </strong>To the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> and middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> (IX-XII <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsy)</li>\n<li><strong>Laterally: </strong>To the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> (present as a <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> of the external <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal).</li>\n<li><strong>Medially:</strong> Invading the <span class=\"customMeta\" data-dictid=\"7732c8e49d169277719171da17de32\">labyrinth</span> and <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> (dizziness and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> palsy).</li>\n</ul>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"243\" src=\"https://image.prepladder.com/content/zpo7ZIJCZDsT1qLJbLuY1746423573.png\" width=\"279\"/></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"186\" src=\"https://image.prepladder.com/content/E5Ge6j6JKnyNzmj20JDH1746423573.png\" width=\"274\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hearing loss (gradually progressive conductive hearing loss)</li>\n<li>Pulsatile <span class=\"customMeta\" data-dictid=\"1e668dc8ba1692777200622a8a97f3\">tinnitus</span> (heartbeat like sounds): It is <span class=\"customMeta\" data-dictid=\"8a823442c116927771993039b6a37d\">synchronous</span> with pulse and can be temporarily stopped by <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> pressure.</li>\n<li>Bleeding from ear (profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in case of polyp)</li>\n<li>Dizziness or <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> and <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> may appear.</li>\n<li>Symptoms like headache, sweating, palpitation, hypertension, anxiety due to <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> (catecholamine release)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> (locally invasive)</li>\n<li>HPE reveals<strong> Zell Ballen pattern,</strong> where <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> chief cells and <span class=\"customMeta\" data-dictid=\"d02faf3d3e16927771998a3442add3\">sustentacular</span> supporting cells <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> clusters (Zell Ballen) encircled by extensive <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> sinusoids.</li>\n<li>Preoperative <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> of the tumour is not performed due to the risk of profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from its highly <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thin-walled blood sinusoids and potential injury to the high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb or <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elsharawy, Mohamed &amp; Alsaif, Hind &amp; Elsaid, Ayman &amp; Kredees, Ali. \" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Well-defined-nests-of-cuboidal-cells-zellballen-are-separated-by-highly-vascularized_fig5_259272100\" data-tags=\"\" height=\"262\" src=\"https://image.prepladder.com/content/bAYJMRPeBi05vNKPwaKR1746423573.png\" width=\"338\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Otoscopy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Red <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> through intact <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and bulging <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <strong>(glomus tympanicum).</strong></li>\n<li><strong>“Rising sun\" appearance</strong> due to the tumor originating from the floor of middle ear<strong> (glomus jugulare).</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Michael Hawke MD, Masafumi Ohki, Shigeru Kikuchi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Glomus_Jugulare_Tumor.jpg https://www.researchgate.net/figure/a-A-red-mass-was-observed-under-the-anterior-quadrant-of-the-tympanic-membrane-b_fig1_334371255\" data-tags=\"\" height=\"170\" src=\"https://image.prepladder.com/content/1CFesPSUnfb5L3AR8oNi1746423573.png\" width=\"462\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>CECT (IOC)</strong> shows <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the carotico-jugular spine on the diseased side, known as <strong>Phelp’s sign.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jones J, Walizai T, Sharma R\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/jugular-paraganglioma\" data-tags=\"\" height=\"274\" src=\"https://image.prepladder.com/content/I6abHj3LLf7Gdn5hWBNA1746423573.png\" width=\"274\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>MRI scan revealed microhemorrhages within the tumor which appear as white and gray dots on MRI, creating a<strong> \"salt and pepper</strong>\" appearance.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"258\" src=\"https://image.prepladder.com/content/33xN8vCWohP6CbAxi1Tx1746423573.png\" width=\"258\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Angiography is used to identify the arteries supplying the tumor.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with CSF otorrhea?", "options": [{"label": "A", "text": "Battle sign", "correct": true}, {"label": "B", "text": "Traumatic rupture of the tympanic membrane", "correct": false}, {"label": "C", "text": "Penetrating injury to the eye", "correct": false}, {"label": "D", "text": "Fracture of the roof of the nose", "correct": false}], "correct_answer": "A. Battle sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gKr76NaKZNEXXhXxwBzx1746427098.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Temporal bone fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cribriform plate(most common)</strong></li>\n<li>Roof of <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> air cells</li>\n<li>Frontal sinus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphenoid sinus(following trauma)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CSF reaches the middle ear, escaping through the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube into the nose(CSF otorhinorrhea)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child was brought to the clinic by her mother with reduced hearing for the past 2-3 months. The otoscopy finding is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hemorrhagic Myringitis bullosa", "correct": true}, {"label": "B", "text": "Serous otitis media", "correct": false}, {"label": "C", "text": "Acute otitis media", "correct": false}, {"label": "D", "text": "Myringitis granulosa", "correct": false}], "correct_answer": "A. Hemorrhagic Myringitis bullosa", "question_images": ["https://image.prepladder.com/content/kpK5qAR3ICYKRi5ZlsiP1746427178.png"], "explanation_images": ["https://image.prepladder.com/content/AMy2kiBnT86UFh7DgC2d1746427212.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which diagnosis is most likely for a patient experiencing painful vesicles in the external auditory meatus and over the tympanic membrane, along with facial nerve palsy? Furthermore, which specific site is affected in this case?", "options": [{"label": "A", "text": "Ramsay Hunt syndrome and basal ganglion", "correct": false}, {"label": "B", "text": "Ramsay Hunt syndrome and geniculate ganglion", "correct": true}, {"label": "C", "text": "Melkersson syndrome and trigeminal ganglion", "correct": false}, {"label": "D", "text": "Melkersson syndrome and otic ganglion", "correct": false}], "correct_answer": "B. Ramsay Hunt syndrome and geniculate ganglion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sOJphZNNZxI9bZUEj1Am1746427965.png", "https://image.prepladder.com/notes/tdWmrJM6Q4N1QwGxb97W1747390798.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the function of utricle and saccule?", "options": [{"label": "A", "text": "Hearing high-frequency sounds", "correct": false}, {"label": "B", "text": "Linear acceleration and deceleration", "correct": true}, {"label": "C", "text": "Angular acceleration", "correct": false}, {"label": "D", "text": "Hearing low-frequency sounds", "correct": false}], "correct_answer": "B. Linear acceleration and deceleration", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zQhJJYmMc0rGpjoRXe9t1746428929.png", "https://image.prepladder.com/content/1df78KJpvGtTFhJNbFLv1746428929.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parts of the Inner Ear</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The inner ear, or labyrinth, is essential for hearing and balance and is located within the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone. It consists of the <span class=\"customMeta\" data-dictid=\"8f50a352d71692777183234f97f2dd\">bony labyrinth</span> and the membranous labyrinth.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"469\" src=\"https://image.prepladder.com/content/zQhJJYmMc0rGpjoRXe9t1746428929.png\" width=\"467\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bony Labyrinth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A rigid structure filled with <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> (a sodium-rich fluid), it has three main parts:</p>\n<ol>\n<li><strong>Vestibule:</strong> Central part connecting to the <span class=\"customMeta\" data-dictid=\"6eb2dc23ea16927771848e85bcecb2\">cochlea</span> and semicircular canals.\n\n\t\t\t\t<ul>\n<li>Bony Recesses in the <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> contains the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> and <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> (part of the membranous labyrinth).\n\t\t\t\t\t<ul>\n<li><strong>Spherical Recess: </strong>Contains the saccule, a membranous <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> involved in detecting <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and deceleration.</li>\n<li>Elliptical Recess: Contains the utricle, which works with the <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> to aid in balance and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> orientation. <strong> </strong></li>\n</ul>\n</li>\n<li>Oval Window: Located on the vestibule’s <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall, it connects to the middle ear.</li>\n<li>Openings of the Semicircular Canals: The three semicircular canals (lateral, posterior, and superior) have five openings into the vestibule, enabling <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of head rotations.</li>\n<li>Opening of the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> Aqueduct: Positioned below the elliptical recess, it allows the passage of the endolymphatic duct, which carries <span class=\"customMeta\" data-dictid=\"5f331cddb3169277718749f0c2a1d9\">endolymph</span> within the membranous labyrinth.</li>\n</ul>\n</li>\n<li><strong>Semicircular Canals:</strong> Three canals (lateral, posterior, and superior) positioned at right angles to detect rotational head movement. Each has an <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> containing the <span class=\"customMeta\" data-dictid=\"855c7f67b916927771851af573bb2a\">crista</span> ampullaris for <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> function.</li>\n<li><strong>Cochlea:</strong> A <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> structure essential for hearing, divided into three chambers (scala vestibuli, <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> tympani, and <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> media). The <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> vestibuli and tympani contain <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> and communicate via the helicotrema, while the <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> media houses the organ of Corti, which converts sound vibrations into electrical signals.</li>\n</ol>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/1df78KJpvGtTFhJNbFLv1746428929.png\" width=\"356\"/></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Membranous Labyrinth</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A delicate system within the bony labyrinth, filled with potassium-rich endolymph, it includes:</p>\n<ol>\n<li><strong>Cochlear <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> (Scala Media):</strong> Inside the cochlea, it separates the <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> vestibuli and <span class=\"customMeta\" data-dictid=\"5f132abacf1692777198df171c92e2\">scala</span> tympani and contains the <span class=\"customMeta\" data-dictid=\"29bb9bd7941692777194f232aa822a\">organ of Corti</span> for hearing.</li>\n<li><strong>Utricle and Saccule:</strong> Membranous sacs in the <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> responsible for detecting <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and balance. They are connected via the <span class=\"customMeta\" data-dictid=\"637ee8854016927772017070137245\">utriculosaccular</span> duct.</li>\n<li><strong>Semicircular Ducts:</strong> Membranous ducts within the bony semicircular canals, contributing to balance.</li>\n<li><strong>Endolymphatic <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> and Sac:</strong> Extending from the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> and saccule, the <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> ends in the endolymphatic sac, important in <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> treatments for conditions like Ménière's disease.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred treatment for a primipara who is experiencing hearing impairment that has worsened during her pregnancy? The Rinne's test yields negative results in both ears, while the Weber's test shows lateralization to the right side. The otoscopy reveals normal tympanic membranes, and audiometry indicates a dip in bone conduction at 2000 Hz.", "options": [{"label": "A", "text": "a.Sodium fluoride", "correct": false}, {"label": "B", "text": "b.Tympanoplasty", "correct": false}, {"label": "C", "text": "c.Stapedectomy", "correct": false}, {"label": "D", "text": "d.Stapedotomy", "correct": true}], "correct_answer": "D. d.Stapedotomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following Wullstein's Classification Procedure/other name A. Type II B. Type III C. Type IV D. Type V 1. Fenestration tympanoplasty 2. Graft placed over the incus 3. Cavum minor 4. Columella tympanoplasty", "options": [{"label": "A", "text": "A-1, B-2, C-3, D-4", "correct": false}, {"label": "B", "text": "A-2, 8-3, C-4, D-1", "correct": false}, {"label": "C", "text": "A-2, B-4, C-3, D-1", "correct": true}, {"label": "D", "text": "A-1, B-3, C-4, D-2", "correct": false}], "correct_answer": "C. A-2, B-4, C-3, D-1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myringoplasty: Repair of a <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> using a graft.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed on <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> or remaining <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> with an eroded <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and <span class=\"customMeta\" data-dictid=\"eabd01cba8169277719581b5b4420b\">perforated</span> <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed directly on <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> head in absence of <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> (myringostapediopexy or <span class=\"customMeta\" data-dictid=\"e03b2f95ab1692777184437bf8f3c5\">columella</span> tympanoplasty).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed between <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> and round windows, exposing <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> (cavum minor), allowing sound to act directly on footplate.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fenestration operation: Creation of a new window on the <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> semicircular canal, covering it with a <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> when the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> is fixed but the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> is functional.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests can be used if the otoacoustic emission test is absent during screening? Pure tone audiometry. Tympanometry Free field audiometry Speech audiometry", "options": [{"label": "A", "text": "a, b", "correct": false}, {"label": "B", "text": "b, c", "correct": false}, {"label": "C", "text": "b, d", "correct": true}, {"label": "D", "text": "a, c", "correct": false}], "correct_answer": "C. b, d", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/jqpIfBMe32SNDhjXOLlQ1745325137.png", "https://image.prepladder.com/notes/ElWI1FU1GZRtsmaCrDrs1745325057.png", "https://image.prepladder.com/notes/45UrcuYUx1TeLH33AGXh1745325017.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cochlear pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retrocochlear pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Speech discrimination</strong></p>\n<p><strong>Score</strong><strong> (Statement d)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>90-100%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Below 90%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Very poor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recruitment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>SISI score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-15%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;70%</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Threshold tone decay</strong></p>\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-15 dB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;25 dB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;25 dB</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedial reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stapedial <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> decay</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abnormal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BERA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal interval between wave I and V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal interval between wave I and V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wave V delayed or absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rollover phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent primarily but seen in old age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6 year old boy presented with recurrent URTI, poor growth, high arched palate, and impaired hearing. His tympanogram is given below. What would be the most appropriate management for him?", "options": [{"label": "A", "text": "Myringotomy", "correct": false}, {"label": "B", "text": "Grommet", "correct": false}, {"label": "C", "text": "Myringotomy and grommet", "correct": false}, {"label": "D", "text": "Adrenoidectomy and grommet", "correct": true}], "correct_answer": "D. Adrenoidectomy and grommet", "question_images": ["https://image.prepladder.com/notes/UQ6n2m01xlqa6BjT2vJD1746698852.png"], "explanation_images": ["https://image.prepladder.com/notes/gqcZe6inRcN8fm3u1Ea51745325570.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tympanogram Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal peak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type As</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shallow peak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ossicular <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (e.g., otosclerosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type Ad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deep peak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ossicular discontinuity or thin <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flat, no peak</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Middle ear fluid or thick <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peak at negative pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eustachian tube dysfunction, <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> negative pressure</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malfunctioning of Eustachian tube</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Allergy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unresolved <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Viral infections</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adenoid hyperplasia</strong>.</li>\n<li><strong>Chronic <span class=\"customMeta\" data-dictid=\"a8dad7cd171692777197e6d4ac2a1c\">rhinitis</span> and sinusitis</strong>.</li>\n<li><strong>Chronic tonsillitis</strong>: Enlarged tonsils obstruct the soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> and affect Eustachian tube function.</li>\n<li><strong>Nasopharyngeal tumours</strong>: Benign or malignant, especially in adults with <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media.</li>\n<li><strong>Palatal defects</strong>: e.g., <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> palate, <span class=\"customMeta\" data-dictid=\"733f60c2581692777194690224e6eb\">palatal</span> paralysis.</li>\n<li><strong>Down's syndrome</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seasonal or <span class=\"customMeta\" data-dictid=\"231e76e11c1692777195bd586f5b59\">perennial</span> allergies obstruct the Eustachian tube and increase <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> mucosal secretions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy can lead to persistent, <span class=\"customMeta\" data-dictid=\"5297b5833216927771910b7a85de53\">low-grade</span> infection, stimulating more <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> production and increasing goblet cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><br/>\n\t\t\tAdenoviruses and rhinoviruses can invade the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> mucosa, leading to increased <span class=\"customMeta\" data-dictid=\"9e7aec9ff416927771984a1e3100b7\">secretory</span> activity.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myringotomy and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">Aspiration</span> of Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> in the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> to <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> fluid; thick <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> may require <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> or <span class=\"customMeta\" data-dictid=\"d3957bd7ec16927771931064fb9a0a\">mucolytic</span> agents like <span class=\"customMeta\" data-dictid=\"97961809dc169277718451f3dd34f5\">chymotrypsin</span> solution.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grommet Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>If fluid recurs after <span class=\"customMeta\" data-dictid=\"43046dc2c016927771930d2538e6d6\">myringotomy</span> and aspiration, a <span class=\"customMeta\" data-dictid=\"efcdc8d2f71692777188341ac61941\">grommet</span> is inserted for continued <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> aeration; remains in place for weeks or months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tympanotomy or Cortical Mastoidectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Required for removing loculated thick fluid or other pathologies like cholesterol granuloma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Treatment of Causative Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Procedures like adenoidectomy, tonsillectomy, and/or maxillary <span class=\"customMeta\" data-dictid=\"880f5f4246169277718114f14f7cbf\">antra</span> <span class=\"customMeta\" data-dictid=\"67d67b341916927772029cd0d951df\">washout</span> may be needed, typically performed during myringotomy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arrange the following in the sequence of auditory pathway: 1. Cochlear nucleus 2. Spiral ganglion 3. Superior olivary nucleus 4. Inferior colliculus 5. Medial geniculate body", "options": [{"label": "A", "text": "1-2-3-4-5", "correct": false}, {"label": "B", "text": "5-4-3-2-1", "correct": false}, {"label": "C", "text": "2-1-3-4-5", "correct": true}, {"label": "D", "text": "3-4-5-1-2", "correct": false}], "correct_answer": "C. 2-1-3-4-5", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/2MyumsmHsu5Xma5fl5aJ1745384480.png", "https://image.prepladder.com/notes/qx1HX2LGli3Er3DbQfWX1745384507.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the grade of tympanic membrane retraction shown in the image according to the Sade classification?", "options": [{"label": "A", "text": "Grade 1", "correct": false}, {"label": "B", "text": "Grade 2", "correct": true}, {"label": "C", "text": "Grade 3", "correct": false}, {"label": "D", "text": "Grade 4", "correct": false}], "correct_answer": "B. Grade 2", "question_images": ["https://image.prepladder.com/notes/BSZl97UXx3dOKcxoYbRX1746708518.png"], "explanation_images": ["https://image.prepladder.com/notes/Y3vAr00eO5muizrYUzgS1746708588.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with complaints of slowly progressive difficulty hearing in the right ear. She also has pulsatile tinnitus. On examination, a reddish mass was seen behind the tympanic membrane, and an audible bruit was heard over the mastoid when auscultation with a stethoscope was performed. Her Rinne test was negative. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "CSOM", "correct": false}, {"label": "B", "text": "ASOM", "correct": false}, {"label": "C", "text": "Mastoiditis", "correct": false}, {"label": "D", "text": "Glomus tumor", "correct": true}], "correct_answer": "D. Glomus tumor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JraWuOxssPuJNbPINCg11745842662.png", "https://image.prepladder.com/content/yGe14XPFEuzrnyhZnbVt1745842670.png", "https://image.prepladder.com/content/LLX66sbejsMwFDyXCQNA1745842683.png", "https://image.prepladder.com/content/Lz3YAEFZtWtdoOZ1tLxw1745842700.png", "https://image.prepladder.com/content/41baNtty94g7XkMFRE0M1745842713.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glomus Tympanicum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glomus Jugulare</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours arise from the<strong> <span class=\"customMeta\" data-dictid=\"2f915d658a1692777196b4f9ce9a74\">promontory</span> of the middle ear. </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours originate from the <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of the <strong>jugular bulb </strong>and can extend into the <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> and surrounding structures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulsatile tinnitus, hearing loss, and a reddish mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulsatile tinnitus, hearing loss, and may involve multiple <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves (IX, X, XI)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Otoscopy findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reddish, <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane.</li>\n<li>This may lead to <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> and a feeling of fullness in the ear.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Masafumi Ohki, Shigeru Kikuchi\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-A-red-mass-was-observed-under-the-anterior-quadrant-of-the-tympanic-membrane-b_fig1_334371255\" data-tags=\"\" height=\"328\" src=\"https://image.prepladder.com/content/JraWuOxssPuJNbPINCg11745842662.png\" width=\"328\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reddish mass behind the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, often pulsatile.</li>\n<li>It is associated with neurological symptoms due to <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve involvement, including <span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\">glossopharyngeal</span> nerve involvement.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Michael Hawke MD\" data-hash=\"\" data-license=\"CC-BY-4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Glomus_Jugulare_Tumor.jpg\" data-tags=\"\" height=\"373\" src=\"https://image.prepladder.com/content/yGe14XPFEuzrnyhZnbVt1745842670.png\" width=\"373\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations of <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">Glomus</span> Tumour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CECT (contrast-enhanced computed tomography) </strong>is the <strong>investigation of choice to distinguish</strong> between <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tympanicum and <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> jugulare tumours and to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> them from an <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, a high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb, or a dehiscent <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb.</li>\n<li><strong>Phelps sign: </strong>On the normal side, the carotico-jugular spine (a dense bone structure between the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> and mastoid) is intact. On the affected side, <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the carotico-jugular spine is observed.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"426\" src=\"https://image.prepladder.com/content/LLX66sbejsMwFDyXCQNA1745842683.png\" width=\"419\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI scan </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It demonstrates the extent of the tumour within the soft tissue.</li>\n<li><strong>Salt and pepper sign: </strong>Microhemorrhages within the tumour are visualized as white and gray dots on MRI, resulting in a <strong>\"salt-and-pepper\" appearance.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sakai, Masafumi &amp; Hiyama, Takashi &amp; Kuno, Hirofumi &amp; Kobayashi, Tatsushi &amp; Nakajima, Takahito.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Paraganglioma-of-a-man-in-his-50s-with-hoarseness-a-d-MRI-shows-a-well-defined-mass_fig2_384200320\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/Lz3YAEFZtWtdoOZ1tLxw1745842700.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Angiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is essential when CT indicates involvement of the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb, <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, or <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> extension. It also aids in identifying additional <span class=\"customMeta\" data-dictid=\"dcd971226c16927771887a3627684d\">glomus</span> tumors, locating <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels, and guiding embolization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Brain <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">Perfusion</span> and Flow Studies </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>These are essential if the tumor compresses the internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n<li>They assess brain perfusion, <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> function, and may involve <span class=\"customMeta\" data-dictid=\"e3827ede5c1692777202c45715fc8e\">xenon</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and <span class=\"customMeta\" data-dictid=\"7cb1c220051692777190be13e8c7cc\">isotope</span> studies to <span class=\"customMeta\" data-dictid=\"7991fb415f16927771887b76483a71\">gauge</span> stroke risk and the need for <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> replacement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histopathological studies show the<strong> Zell Ballen pattern,</strong> where <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> chief cells and <span class=\"customMeta\" data-dictid=\"d02faf3d3e16927771998a3442add3\">sustentacular</span> supporting cells <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> clusters (Zell Ballen) encircled by extensive <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> sinusoids.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elsharawy, Mohamed &amp; Alsaif, Hind &amp; Elsaid, Ayman &amp; Kredees, Ali. \" data-hash=\"\" data-license=\"CC BY-NC-ND 4.0\" data-source=\"https://www.researchgate.net/figure/Well-defined-nests-of-cuboidal-cells-zellballen-are-separated-by-highly-vascularized_fig5_259272100\" data-tags=\"\" height=\"310\" src=\"https://image.prepladder.com/content/41baNtty94g7XkMFRE0M1745842713.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Preoperative <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> of the tumour is not performed due to the risk of profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from its highly <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> thin-walled blood sinusoids and potential injury to the high <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> bulb or <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the objective tests used to assess hearing ability? A. BERA (Brainstem evoked response audiometry) B. OAE (Otoacoustic emission) C. PTA (Pure tone audiometry) D. Tympanometry", "options": [{"label": "A", "text": "A, B and D", "correct": false}, {"label": "B", "text": "A, B and C", "correct": false}, {"label": "C", "text": "B, C and D", "correct": false}, {"label": "D", "text": "A, B, C and D", "correct": true}], "correct_answer": "D. A, B, C and D", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is responsible for the syncopal episode that occurred during the syringing procedure for ear wax removal in a patient?", "options": [{"label": "A", "text": "Auriculotemporal nerve", "correct": false}, {"label": "B", "text": "Arnold’s nerve", "correct": true}, {"label": "C", "text": "Glossopharyngeal nerve", "correct": false}, {"label": "D", "text": "Jacobson’s nerve", "correct": false}], "correct_answer": "B. Arnold’s nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The probable diagnosis for a 60-year-old diabetic patient who is experiencing intense ear pain and otorrhea that has not improved with antibiotics, along with the presence of granulation tissue in the ear canal and facial nerve paralysis, is:", "options": [{"label": "A", "text": "Otomycosis", "correct": false}, {"label": "B", "text": "Serous otitis media", "correct": false}, {"label": "C", "text": "Malignant otitis externa", "correct": true}, {"label": "D", "text": "Eczematous otitis externa", "correct": false}], "correct_answer": "C. Malignant otitis externa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jnP5eGFvDM0HCk2XUnhO1745843643.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the subsequent course of treatment for a child with bilateral sensorineural hearing loss who did not experience any improvement after using hearing aids?", "options": [{"label": "A", "text": "Bone anchored hearing aid", "correct": false}, {"label": "B", "text": "Tympanoplasty", "correct": false}, {"label": "C", "text": "Normal hearing aid", "correct": false}, {"label": "D", "text": "Cochlear implant", "correct": true}], "correct_answer": "D. Cochlear implant", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with the presence of a B tympanogram?", "options": [{"label": "A", "text": "Ossicular dislocation", "correct": false}, {"label": "B", "text": "Otosclerosis", "correct": false}, {"label": "C", "text": "Serous otitis media", "correct": true}, {"label": "D", "text": "Normal ear", "correct": false}], "correct_answer": "C. Serous otitis media", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/25NoTb3pCi5TRwNvJ0la1747897870.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young lady presented to the ENT OPD with a history of sudden onset unilateral hearing loss, tinnitus, and dizziness following an episode of acute otitis media two weeks back. Rinne’s test and fistula test were positive. She had refused treatment then and currently came with complaints of worsened hearing loss in the affected ear. On examination, the fistula test was negative. What would be the most likely finding on the Rinne test in this scenario?", "options": [{"label": "A", "text": "True positive", "correct": true}, {"label": "B", "text": "True negative", "correct": false}, {"label": "C", "text": "False positive", "correct": false}, {"label": "D", "text": "False negative", "correct": false}], "correct_answer": "A. True positive", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Battle sign?", "options": [{"label": "A", "text": "Mastoid ecchymosis", "correct": true}, {"label": "B", "text": "Periorbital hematoma", "correct": false}, {"label": "C", "text": "Bezold abscess", "correct": false}, {"label": "D", "text": "Perichondritis", "correct": false}], "correct_answer": "A. Mastoid ecchymosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your diagnosis for a patient who has presented with symptoms of vertigo, tinnitus, and fullness of ears. The symptoms improve on keeping the right ear up. He had previously been operated on for a safe type of right side chronic suppurative otitis media (CSOM) six months ago?", "options": [{"label": "A", "text": "Perilymphatic fistula", "correct": true}, {"label": "B", "text": "Labyrinthitis", "correct": false}, {"label": "C", "text": "Paget disease", "correct": false}, {"label": "D", "text": "Vestibular schwannoma", "correct": false}], "correct_answer": "A. Perilymphatic fistula", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur after head trauma, <span class=\"customMeta\" data-dictid=\"5b92d758801692777182d17f9d55bc\">barotrauma</span> (e.g., diving), <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone anomalies, or ear surgery (e.g., stapedectomy).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluctuating <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> hearing loss, vertigo, tinnitus, and sometimes a sense of fullness in the ear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> (especially in children with <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone defects), <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) leak.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often clinical, based on history and symptoms; confirmed through <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> exploration if suspected.</p>\n<p><a href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/temporal-bone\"><strong>Temporal bone</strong></a><strong> </strong><a href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/computer-assisted-tomography\"><strong>CT</strong></a><strong>:</strong> Shows pneumolabyrinth, accumulation of fluid in the middle ear, and/or <span class=\"customMeta\" data-dictid=\"22d574e4221692777194933e257251\">ossicular chain</span> disruption, but also can often be normal.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> to prevent further complications, such as meningitis; limited improvement in hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hearing improvement post-surgery is usually limited; however, <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> symptoms often improve or resolve.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man presented with hearing loss and tinnitus. Histology image is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Neurofibroma", "correct": false}, {"label": "B", "text": "Schwannoma", "correct": true}, {"label": "C", "text": "Leiomyoma", "correct": false}, {"label": "D", "text": "Rhabdomyoma", "correct": false}], "correct_answer": "B. Schwannoma", "question_images": ["https://image.prepladder.com/notes/sMc80SQeD78frFmsf72m1747046954.png"], "explanation_images": ["https://image.prepladder.com/content/AkCXGawbMgSGjtHpmc8C1745566911.png", "https://image.prepladder.com/content/gV1mV35xb1fLVWrzPMWP1745566928.png", "https://image.prepladder.com/content/fSZQNxdeXCtCZ4DUBNnj1745566941.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Origin: Schwann cells; Site: CP angle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Antoni A areas:</strong> These areas are composed of tightly packed spindle-shaped cells with elongated nuclei. The cells are arranged in palisades or whorls, forming Verocay bodies. The cells in Antoni A areas exhibit nuclear <span class=\"customMeta\" data-dictid=\"ecda6415021692777189c07e38b84f\">hyperchromasia</span> (increased <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> intensity) and <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> cohesion.</li>\n<li><strong>Antoni B areas: </strong>These areas are less <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> and show a looser arrangement of cells with a <span class=\"customMeta\" data-dictid=\"58f239fc181692777193528b77cc8c\">myxoid</span> or microcystic appearance. The cells in Antoni B areas may have more <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and a less distinct cytoplasmic organization compared to Antoni A areas.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>40-60 years, Males = Females</li>\n<li>Unilateral <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> associated with tinnitus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice/Gold standard: MRI with Gadolinium contrast</strong> - <strong>ice cream cone</strong> appearance seen on <strong>CP angle</strong>.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ranchod A, Rongpipi T, Rasuli B, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/ice-cream-cone-sign-vestibular-schwannoma\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/AkCXGawbMgSGjtHpmc8C1745566911.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Other investigations:</strong>\n<ul>\n<li>CT (with/without contrast): done when MRI is not feasible</li>\n<li>Vertebral Angiography: though helps in localizing the tumor, it is not the investigation of choice.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Neurofibromatosis type-2 (NF-2):</strong> Presents with <strong>bilateral Schwannomas</strong> and other tumors like Meningioma, <span class=\"customMeta\" data-dictid=\"6b6651fe371692777187b56a108dfd\">ependymoma</span> may also be associated.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential diagnoses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CP angle meningioma: </strong></p>\n<ul>\n<li><strong>MRI: Dural tail sign seen</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Bell D, Thibodeau R, et al\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/dural-tail-sign-1\" data-tags=\"\" height=\"314\" src=\"https://image.prepladder.com/content/gV1mV35xb1fLVWrzPMWP1745566928.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glomus tumor: (Glomus jugulare)</strong></p>\n<ul>\n<li>Arises from the <span class=\"customMeta\" data-dictid=\"48872daf681692777186072f36702a\">dome</span> of <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">Jugular</span> bulb within the <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> fossa.</li>\n<li><strong>CT: Phelp sign</strong> (Bony <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> seen between <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> and <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> fossa)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Chris O'Donnell\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/jugular-paraganglioma-11#image-10861969\" data-tags=\"\" height=\"319\" src=\"https://image.prepladder.com/content/fSZQNxdeXCtCZ4DUBNnj1745566941.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following devices can be used in a patient with bilateral external auditory atresia?", "options": [{"label": "A", "text": "1", "correct": true}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "A. 1", "question_images": ["https://image.prepladder.com/notes/qEFuJZa6zWB3ux1hVz7G1747048181.png", "https://image.prepladder.com/notes/bxSkmesS9Zx37WwdGd9Y1747048199.png", "https://image.prepladder.com/notes/9DjMrjBEYwhIXuq7XO3k1747048221.png", "https://image.prepladder.com/notes/hUq0W3PPx04a3aFTwpUe1747048249.png"], "explanation_images": ["https://image.prepladder.com/content/IrsP74osHiFvsKtD5e4H1745568149.png", "https://image.prepladder.com/content/r45yyhNRgkf70o1Wu5Tj1745568160.png"], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of chronic ear infection presents with fever, headache, vomiting, irritability, and confusion. His CT brain is shown in the image below. What is the possible diagnosis?", "options": [{"label": "A", "text": "Temporal lobe abscess", "correct": true}, {"label": "B", "text": "Cerebellar abscess", "correct": false}, {"label": "C", "text": "Subdural abscess", "correct": false}, {"label": "D", "text": "Meningitis", "correct": false}], "correct_answer": "A. Temporal lobe abscess", "question_images": ["https://image.prepladder.com/content/OTOIFD0uy5QIdthMUj0A1745476266.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\"&gt;Temporal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\"&gt;lobe&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnostic maneuver performed by an ENT surgeon when a patient presents with vertigo but no hearing loss?", "options": [{"label": "A", "text": "Yacovino maneuver", "correct": false}, {"label": "B", "text": "Dix-Hallpike maneuver", "correct": true}, {"label": "C", "text": "Epley’s maneuver", "correct": false}, {"label": "D", "text": "Simon’s maneuver", "correct": false}], "correct_answer": "B. Dix-Hallpike maneuver", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Determine the accurate order of the pathways involved in the auditory system. A. Superior Olivary nucleus B. Cochlear Nucleus C. Inferior Colliculi D. Lateral lemniscus E. Medial geniculate ganglion", "options": [{"label": "A", "text": "ABCDE", "correct": false}, {"label": "B", "text": "BADCE", "correct": true}, {"label": "C", "text": "BACDE", "correct": false}, {"label": "D", "text": "BAEDC", "correct": false}], "correct_answer": "B. BADCE", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a case of otitis media, which of the following is absent?", "options": [{"label": "A", "text": "Bezold abscess", "correct": false}, {"label": "B", "text": "Griesinger’s sign", "correct": false}, {"label": "C", "text": "Battle sign", "correct": true}, {"label": "D", "text": "Delta sign", "correct": false}], "correct_answer": "C. Battle sign", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests are used to objectively assess hearing ability? BERA (Brainstem Evoked Response Audiometry) OAE (Otoacoustic Emission) PTA (Pure Tone Audiometry) Tympanometry", "options": [{"label": "A", "text": "1, 2 and 4", "correct": true}, {"label": "B", "text": "1, 2 and 3", "correct": false}, {"label": "C", "text": "2, 3 and 4", "correct": false}, {"label": "D", "text": "1, 2, 3 and 4", "correct": false}], "correct_answer": "A. 1, 2 and 4", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male came to the hospital with a history of trauma to the ear. On examination, the ear has swelling, tenderness, and discoloration. Which of the following is false regarding the given image?", "options": [{"label": "A", "text": "All cases should receive prophylactic antibiotics", "correct": false}, {"label": "B", "text": "May lead to Pugilistic ear", "correct": false}, {"label": "C", "text": "Caused by accumulation of blood in perichondrial space", "correct": false}, {"label": "D", "text": "Resolves spontaneously", "correct": true}], "correct_answer": "D. Resolves spontaneously", "question_images": ["https://image.prepladder.com/content/owqGZzS4h7BZVF6TFkR31745480633.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the surgical procedure performed to enlarge the cartilaginous segment of the outer ear canal?", "options": [{"label": "A", "text": "Meatoplasty", "correct": true}, {"label": "B", "text": "Tympanoplasty", "correct": false}, {"label": "C", "text": "Myringoplasty", "correct": false}, {"label": "D", "text": "Otoplasty", "correct": false}], "correct_answer": "A. Meatoplasty", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Stimulation of which of the following causes cough when the external acoustic canal is scratched?", "options": [{"label": "A", "text": "Auriculotemporal nerve", "correct": false}, {"label": "B", "text": "Auricular branch of vagus", "correct": true}, {"label": "C", "text": "Great auricular nerve", "correct": false}, {"label": "D", "text": "Facial nerve", "correct": false}], "correct_answer": "B. Auricular branch of vagus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\"&gt;Auricular&lt;/span&gt; branch of vagu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person who met with an accident and suffered from a skull fracture presents with the following finding. Identify this clinical finding.", "options": [{"label": "A", "text": "Battle sign", "correct": true}, {"label": "B", "text": "Bezold abscess", "correct": false}, {"label": "C", "text": "Mastoiditis", "correct": false}, {"label": "D", "text": "Griesinger sign", "correct": false}], "correct_answer": "A. Battle sign", "question_images": ["https://image.prepladder.com/content/meIgSBVRWY8hwwWeGwtC1745220868.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - Battle sig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "From which of the following structures does the saccule develop?", "options": [{"label": "A", "text": "Saculus anterior", "correct": false}, {"label": "B", "text": "Saculus posterior", "correct": false}, {"label": "C", "text": "Pars superior", "correct": false}, {"label": "D", "text": "Pars inferior", "correct": true}], "correct_answer": "D. Pars inferior", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not represent a characteristic of tubercular otitis media?", "options": [{"label": "A", "text": "Ear ache", "correct": true}, {"label": "B", "text": "Multiple perforations", "correct": false}, {"label": "C", "text": "Pale granulation", "correct": false}, {"label": "D", "text": "Foul smelling ear discharge", "correct": false}], "correct_answer": "A. Ear ache", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not seen in Meniere's Disease?", "options": [{"label": "A", "text": "Tinnitus", "correct": false}, {"label": "B", "text": "Vertigo", "correct": false}, {"label": "C", "text": "Fullness of ear", "correct": false}, {"label": "D", "text": "Ear Pain", "correct": true}], "correct_answer": "D. Ear Pain", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vD5845FVzNiAnJzsYCjN1746704725.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Excess <strong>endolymph accumulation</strong> (endolymphatic hydrops)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Triad of Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Vertigo</strong> (episodic, lasts minutes to hours)</p>\n<p>2. <strong>Tinnitus</strong> (low-frequency, <span class=\"customMeta\" data-dictid=\"2499b2018a16927771978059423918\">roaring</span> type)</p>\n<p>3. <strong>Hearing loss</strong> (sensorineural, fluctuating, progressive)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aural fullness</strong> (blocked ear sensation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Not Typically Seen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ear pain</strong>, except in secondary infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical + <strong>Audiometry</strong> (low-frequency SNHL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dietary modifications (low sodium), diuretics, <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> suppressants, <span class=\"customMeta\" data-dictid=\"f50648764c16927771908f5217bb54\">intratympanic</span> steroids, and surgery in <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is characterized by the presence of both reservoir sign and mastoid tenderness?", "options": [{"label": "A", "text": "Otosclerotic lesion", "correct": false}, {"label": "B", "text": "Acute mastoiditis", "correct": true}, {"label": "C", "text": "Intratympanic glomus tumor", "correct": false}, {"label": "D", "text": "Chronic suppurative otitis media", "correct": false}], "correct_answer": "B. Acute mastoiditis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Hallpike maneuver aids in the assessment of which of the following?", "options": [{"label": "A", "text": "Vestibular function", "correct": true}, {"label": "B", "text": "Audiometry", "correct": false}, {"label": "C", "text": "Cochlear function", "correct": false}, {"label": "D", "text": "Corneal test", "correct": false}], "correct_answer": "A. Vestibular function", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6ICLwW6153OtnUWyiEku1747121098.png"], "explanation": "<p>Correct Answer A- &lt;span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\"&gt;Vestibular&lt;/span&gt; fu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male presents to the with a three-day history of severe headache, fever, and nausea. He also reports experiencing pain and swelling behind his left ear and blood-tinged ear discharge. On examination tenderness and bluish discoloration over the mastoid process of the left temporal bone is observed. His CT showed an empty delta sign. What is the likely diagnosis?", "options": [{"label": "A", "text": "Meningitis", "correct": false}, {"label": "B", "text": "Lateral sinus thrombosis", "correct": true}, {"label": "C", "text": "Brain Abscess", "correct": false}, {"label": "D", "text": "Extradural Abscess", "correct": false}], "correct_answer": "B. Lateral sinus thrombosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- &lt;span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\"&gt;Lateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\"&gt;sinus&lt;/span&gt; th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the given options is most likely to cause sensory neural hearing loss?", "options": [{"label": "A", "text": "Labyrinthitis", "correct": true}, {"label": "B", "text": "Otosclerosis", "correct": false}, {"label": "C", "text": "Ear wax", "correct": false}, {"label": "D", "text": "CSOM", "correct": false}], "correct_answer": "A. Labyrinthitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A- Labyrinth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement accurately describes BERA (Brainstem Evoked Response Audiometry)?", "options": [{"label": "A", "text": "It can be used for screening for hearing loss", "correct": false}, {"label": "B", "text": "It is an invasive procedure", "correct": false}, {"label": "C", "text": "It can be used for assessing sensorineural hearing loss", "correct": true}, {"label": "D", "text": "It is a subjective investigation", "correct": false}], "correct_answer": "C. It can be used for assessing sensorineural hearing loss", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- It can be used for assessing &lt;span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\"&gt;sensorineural&lt;/span&gt; hearing loss.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 3-year-old child, who has severe Sensorineural deafness and does not show any improvement with hearing aids, but has intact auditory nerve function, which procedure is recommended as the first choice?", "options": [{"label": "A", "text": "Hearing Aids", "correct": false}, {"label": "B", "text": "BAHA", "correct": false}, {"label": "C", "text": "Cochlear implant", "correct": true}, {"label": "D", "text": "Auditory Brainstem Implant", "correct": false}], "correct_answer": "C. Cochlear implant", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Coch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While performing a caloric test, what type of nystagmus would you expect on cold water irrigation ?", "options": [{"label": "A", "text": "Nystagmus towards the same side", "correct": false}, {"label": "B", "text": "Nystagmus towards the opposite side", "correct": true}, {"label": "C", "text": "Central nystagmus", "correct": false}, {"label": "D", "text": "Positional nystagmus", "correct": false}], "correct_answer": "B. Nystagmus towards the opposite side", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - &lt;span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\"&gt;nystagmus&lt;/span&gt; towards th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 60-year-old individual with diabetes who is experiencing intense ear pain and otorrhea that is not improving with antibiotics? During examination, the presence of granulation tissue in the ear canal and facial nerve paralysis was observed?", "options": [{"label": "A", "text": "Otomycosis", "correct": false}, {"label": "B", "text": "Serous otitis media", "correct": false}, {"label": "C", "text": "Malignant otitis externa", "correct": true}, {"label": "D", "text": "Eczematous otitis externa", "correct": false}], "correct_answer": "C. Malignant otitis externa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/l42Ch6UOdhfer32OoHDx1714130902.png"], "explanation": "<p>Correct Option C - Malignant &lt;span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\"&gt;otitis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the potential clinical diagnosis for a 35-year-old man who visited the clinic reporting intermittent dizziness, sensation of pressure and fullness in the ear, reduced hearing, and a low-frequency roaring sound in the ears?", "options": [{"label": "A", "text": "Meniere’s disease", "correct": true}, {"label": "B", "text": "Benign paroxysmal positional vertigo", "correct": false}, {"label": "C", "text": "Labyrinthitis", "correct": false}, {"label": "D", "text": "Syncope", "correct": false}], "correct_answer": "A. Meniere’s disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/y55urgu8A5iYdNcwlWGX1713339072.png"], "explanation": "<p>Correct Option A - Meniere’\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the subsequent conditions is Bone Anchored Hearing Aid (BAHA) implemented?", "options": [{"label": "A", "text": "Sensorineural hearing loss", "correct": false}, {"label": "B", "text": "Acoustic neuroma", "correct": false}, {"label": "C", "text": "Congenital external auditory atresia", "correct": true}, {"label": "D", "text": "Otitis media", "correct": false}], "correct_answer": "C. Congenital external auditory atresia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yv7XoI1NpdvDuTNNFBYy1713339136.png"], "explanation": "<p>Correct Option C - Congenital external &lt;span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\"&gt;auditory&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "You see a child with delayed speech development as part of a health visit at a local school. The otoscopic appearance of the ear is shown below. Hearing loss of 20 dB is detected in audiometric tests. What is your diagnosis?", "options": [{"label": "A", "text": "Acute suppurative otitis media", "correct": false}, {"label": "B", "text": "Serous otitis media", "correct": true}, {"label": "C", "text": "Chronic suppurative otitis media", "correct": false}, {"label": "D", "text": "Glomus tumor", "correct": false}], "correct_answer": "B. Serous otitis media", "question_images": ["https://image.prepladder.com/content/RkYmPR59uDiUxF839wJe1713339243.png"], "explanation_images": ["https://image.prepladder.com/content/k3XuYNDpsqZsLpovDDjI1713339279.png", "https://image.prepladder.com/content/gDn8NL95BLnqslpWucQX1713339293.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\"&gt;Serous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\"&gt;otitis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a branch of the external carotid artery (ECA) supplying the nasal septum?", "options": [{"label": "A", "text": "Anterior ethmoidal artery", "correct": true}, {"label": "B", "text": "Sphenopalatine artery", "correct": false}, {"label": "C", "text": "Greater palatine artery", "correct": false}, {"label": "D", "text": "Superior labial artery", "correct": false}], "correct_answer": "A. Anterior ethmoidal artery", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Vessel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Source</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">Ethmoidal</span> Artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ophthalmic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (Internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> branch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenopalatine Artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maxillary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (External <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> branch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Greater <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">Palatine</span> Artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maxillary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (External <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> branch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">Labial</span> Artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (External <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> branch)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28 years female patient presented with history of bilateral hearing loss and tinnitus. She can hear better in noisy environment. Examination showed intact eardrums bilaterally and Rinne test is negative bilaterally. Pure tone audiometry given below. What is the most probable diagnosis ?", "options": [{"label": "A", "text": "Meniere’s disease", "correct": false}, {"label": "B", "text": "Endolymphatic fistula", "correct": false}, {"label": "C", "text": "Stapedial otosclerosis", "correct": true}, {"label": "D", "text": "Vestibular schwannoma", "correct": false}], "correct_answer": "C. Stapedial otosclerosis", "question_images": ["https://image.prepladder.com/content/7y32ueFzQvMAwFh8rDOU1713348124.png"], "explanation_images": [], "explanation": "<p>Correct Option C - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not contribute to the development of head and neck malignancies?", "options": [{"label": "A", "text": "EBV infection", "correct": false}, {"label": "B", "text": "HPV infection", "correct": false}, {"label": "C", "text": "Betel nut", "correct": false}, {"label": "D", "text": "Vitamin A deficiency", "correct": true}], "correct_answer": "D. Vitamin A deficiency", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arrange the following components of the auditory pathway in the correct sequence from the outermost part to the innermost part: Lateral lemniscus Cochlear nuclei Medial geniculate body Inferior colliculus", "options": [{"label": "A", "text": "2,1,3,4", "correct": false}, {"label": "B", "text": "2,1,4,3", "correct": true}, {"label": "C", "text": "1,2,4,3", "correct": false}, {"label": "D", "text": "1,2,3,4", "correct": false}], "correct_answer": "B. 2,1,4,3", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man with history of ear infection presents with a smooth erythematous swelling on mastoid process as shown below. What is the most likely diagnosis ?", "options": [{"label": "A", "text": "Furunculosis", "correct": false}, {"label": "B", "text": "Acute mastoiditis", "correct": true}, {"label": "C", "text": "Fibrous dysplasia", "correct": false}, {"label": "D", "text": "Facial palsy", "correct": false}], "correct_answer": "B. Acute mastoiditis", "question_images": ["https://image.prepladder.com/content/oNmSIUwtnmcuil4BniWq1713348204.png"], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary cause of MALIGNANT OTITIS EXTERNA?", "options": [{"label": "A", "text": "Staphylococcus aureus", "correct": false}, {"label": "B", "text": "Streptococcus pyogenes", "correct": false}, {"label": "C", "text": "Hemophillus influenza", "correct": false}, {"label": "D", "text": "Pseudomonas aeruginosa", "correct": true}], "correct_answer": "D. Pseudomonas aeruginosa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: &lt;span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\"&gt;Pseudomonas&lt;/span&gt; aerug\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle pairs aid in the processes of both opening and closing the eustachian tube?", "options": [{"label": "A", "text": "Palatopharyngeus and salphinopharyngeus", "correct": false}, {"label": "B", "text": "Tensor veli palatini and levator veli palatini", "correct": true}, {"label": "C", "text": "Tensor tympani and tensor veli palatini", "correct": false}, {"label": "D", "text": "Stylohyoid and geniohyoid", "correct": false}], "correct_answer": "B. Tensor veli palatini and levator veli palatini", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\"&gt;Tensor&lt;/span&gt; veli palatini and &lt;span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\"&gt;levator&lt;/span&gt; v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a characteristic of Meniere's disease?", "options": [{"label": "A", "text": "Low frequency sensorineural hearing loss", "correct": false}, {"label": "B", "text": "Idiopathic", "correct": false}, {"label": "C", "text": "Endolymphatic pathology", "correct": false}, {"label": "D", "text": "Radiofrequency ablation is the treatment of choice", "correct": true}], "correct_answer": "D. Radiofrequency ablation is the treatment of choice", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ax5jhTmtFCJcCiwAyoib1714373448.png"], "explanation": "<p>Correct Option D: &lt;span class=\"customMeta\" data-dictid=\"07f73f8986169277719716f3a62e1b\"&gt;Radiofrequency&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\"&gt;ablation&lt;/span&gt; is the treatment of ch\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute attack</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic phase</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vestibular sedatives</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dimenhydrinate, promethazine, prochlorperazine</li>\n<li>Diazepam suppresses activity of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nucleus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prochlorperazine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vasodilators</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Carbogen (5% CO<sub>2</sub> with 95% O<sub>2</sub>)</li>\n<li>Histamine drip</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nicotinic acid</li>\n<li>Betahistine (Vertin)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Other drugs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atropine</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diuretics</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Conservative procedures (preserve hearing)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Destructive procedure (Destroy hearing)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vestibular nerve sectioning</li>\n<li>Decompression of endolymphatic sac</li>\n<li>Endolymphatic shunt</li>\n<li>Sacculotomy (Ficks procedure)</li>\n<li>Cody tack procedure</li>\n<li>Cochleosacculostomy (cochlear <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> is punctured)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Labyrinthectomy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Eustachian tube develops from which pharyngeal pouch?", "options": [{"label": "A", "text": "2nd and 3rd pharyngeal pouch", "correct": false}, {"label": "B", "text": "1st pharyngeal pouch", "correct": true}, {"label": "C", "text": "2nd pharyngeal pouch", "correct": false}, {"label": "D", "text": "3rd pharyngeal pouch", "correct": false}], "correct_answer": "B. 1st pharyngeal pouch", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 1st pharyngeal pouch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common cause of facial nerve palsy?", "options": [{"label": "A", "text": "Idiopathic Bell's palsy", "correct": true}, {"label": "B", "text": "Herpes zoster oticus", "correct": false}, {"label": "C", "text": "Mastoid surgery", "correct": false}, {"label": "D", "text": "Chronic suppurative Otitis media", "correct": false}], "correct_answer": "A. Idiopathic Bell's palsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\"&gt;Idiopathic&lt;/span&gt; B\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Idiopathic (Bell's palsy)</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden onset of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> weakness or paralysis</li>\n<li>Difficulty closing one eye</li>\n<li>Drooping of the mouth or eyelid</li>\n</ul>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical examination of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> muscles</li>\n<li>History and physical examination</li>\n<li>Assessing <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> movements and muscle strength</li>\n</ul>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corticosteroids</li>\n<li>Eye protection (eye patch or lubricating eye drops)</li>\n<li>Facial exercises and physical therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with recruitment phenomenon?", "options": [{"label": "A", "text": "Otitis media with effusion", "correct": false}, {"label": "B", "text": "Acoustic nerve schwannoma", "correct": false}, {"label": "C", "text": "Meniere's disease", "correct": true}, {"label": "D", "text": "Otosclerosis", "correct": false}], "correct_answer": "C. Meniere's disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "21 years old patient came to your clinic with complaints of recurrent pain in the neck and ear. You made an initial diagnosis of the syndrome involved in relation to the below-marked bone. Which of the following nerve is responsible for the referred pain in the ear?", "options": [{"label": "A", "text": "Auriculotemporal nerve", "correct": false}, {"label": "B", "text": "Posterior auricular nerve", "correct": false}, {"label": "C", "text": "Occipital nerve", "correct": false}, {"label": "D", "text": "Glossopharyngeal nerve", "correct": true}], "correct_answer": "D. Glossopharyngeal nerve", "question_images": ["https://image.prepladder.com/content/a3v7sL89nHFZ7bGgfMWN1713348020.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Glossopharyngeal nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not characterize tubercular otitis media?", "options": [{"label": "A", "text": "Ear ache", "correct": true}, {"label": "B", "text": "Multiple perforations", "correct": false}, {"label": "C", "text": "Pale granulation", "correct": false}, {"label": "D", "text": "Foul smelling ear discharge", "correct": false}], "correct_answer": "A. Ear ache", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ear ach\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is accurate regarding keratosis obturans?", "options": [{"label": "A", "text": "Failure of migration of desquamated epithelium along posterior meatal wall", "correct": false}, {"label": "B", "text": "Widening of meatus and facial nerve palsy might be seen", "correct": false}, {"label": "C", "text": "Associated bronchiectasis and sinusitis", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following instrument is used in", "options": [{"label": "A", "text": "Septoplasty", "correct": false}, {"label": "B", "text": "Myringoplasty", "correct": false}, {"label": "C", "text": "Myringotomy", "correct": true}, {"label": "D", "text": "Adenoidectomy", "correct": false}], "correct_answer": "C. Myringotomy", "question_images": ["https://image.prepladder.com/content/G7YbMd2ghG3vOp0sbETq1713347243.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Myring\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the electrode placed in cochlear implant procedures?", "options": [{"label": "A", "text": "Round window", "correct": false}, {"label": "B", "text": "Oval window", "correct": false}, {"label": "C", "text": "Scala vestibule", "correct": false}, {"label": "D", "text": "Scala tympani", "correct": true}], "correct_answer": "D. Scala tympani", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3BTCt76kFsQVeU0cNqOF1714380840.png"], "explanation": "<p>Correct Option D: S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mainstay of treatment of glue ear?", "options": [{"label": "A", "text": "Radical Mastoidectomy", "correct": false}, {"label": "B", "text": "Myringotomy + aeration to middle ear", "correct": true}, {"label": "C", "text": "Temporal bone resection", "correct": false}, {"label": "D", "text": "Tonsillectomy &amp;amp; adenoidectomy", "correct": false}], "correct_answer": "B. Myringotomy + aeration to middle ear", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"43046dc2c016927771930d2538e6d6\"&gt;Myringotomy&lt;/span&gt; + &lt;span class=\"customMeta\" data-dictid=\"ec8505f749169277718070157610a9\"&gt;aeration&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Picket fence fever is a feature of which of the following in", "options": [{"label": "A", "text": "Lateral sinus thrombophlebitis", "correct": true}, {"label": "B", "text": "Quincy", "correct": false}, {"label": "C", "text": "Laryngitis sicca", "correct": false}, {"label": "D", "text": "Croup", "correct": false}], "correct_answer": "A. Lateral sinus thrombophlebitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\"&gt;Lateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\"&gt;sinus&lt;/span&gt; thromboph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Why is cold water not used for syringing?", "options": [{"label": "A", "text": "Cold water leads to wax impaction", "correct": false}, {"label": "B", "text": "Cold water leads to foreign body impaction", "correct": false}, {"label": "C", "text": "Can cause tympanic membrane rupture", "correct": false}, {"label": "D", "text": "It causes vertigo by caloric stimulation", "correct": true}], "correct_answer": "D. It causes vertigo by caloric stimulation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - It causes &lt;span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\"&gt;vertigo&lt;/span&gt; by &lt;span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\"&gt;caloric&lt;/span&gt; stimu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does a dip at 4000Hz indicate in pure tone audiometry?", "options": [{"label": "A", "text": "Otosclerosis", "correct": false}, {"label": "B", "text": "Meniere's disease", "correct": false}, {"label": "C", "text": "Noise induced hearing loss", "correct": true}, {"label": "D", "text": "Age related hearing loss", "correct": false}], "correct_answer": "C. Noise induced hearing loss", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Noise &lt;span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\"&gt;induced&lt;/span&gt; hearing\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In parotid gland surgery, which of the subsequent structures serves as a reference point for the facial nerve?", "options": [{"label": "A", "text": "Tragal pointer", "correct": true}, {"label": "B", "text": "Posterior border of mylohyoid", "correct": false}, {"label": "C", "text": "Tip of helix", "correct": false}, {"label": "D", "text": "Styloid process", "correct": false}], "correct_answer": "A. Tragal pointer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"473c9d41411692777200a97f44dd69\"&gt;Tragal&lt;/span&g\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Facial Nerve</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Landmark in <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">Parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">Gland</span> Surgery</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Facial Nerve</p>\n</td>\n<td>\n<p>- Emerges from <span class=\"customMeta\" data-dictid=\"10a9865a511692777199f3007e4f54\">stylomastoid</span> <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> - Courses through the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> gland</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Landmark 1</p>\n</td>\n<td>\n<p>Tragal <span class=\"customMeta\" data-dictid=\"12f1ba6f0f16927771964563dc0c2d\">pointer</span> (small <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> at the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> margin of the <span class=\"customMeta\" data-dictid=\"e8a77282b816927772006578f87e08\">tragus</span> of the ear)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Landmark 2</p>\n</td>\n<td>\n<p>Retromandibular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> (used to locate the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve branches)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Landmark 3</p>\n</td>\n<td>\n<p>Anterior border of the <span class=\"customMeta\" data-dictid=\"ebf38dd1b416927771994e550b0d1e\">sternocleidomastoid</span> muscle (used to guide the <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Landmark 4</p>\n</td>\n<td>\n<p>Transverse <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (crosses the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and aids in identifying the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> nerve)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following features is not associated with superior semicircular canal dehiscence syndrome ?", "options": [{"label": "A", "text": "Gaze dependent nystagmus", "correct": false}, {"label": "B", "text": "Positive Fistula test", "correct": false}, {"label": "C", "text": "Sensorineural hearing loss", "correct": true}, {"label": "D", "text": "Positive tullo phenomenon", "correct": false}], "correct_answer": "C. Sensorineural hearing loss", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\"&gt;Sensorineural&lt;/span&gt; hearing\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient undergoes surgery of the lateral part of the base of the skull. Postoperatively, the patient presents with aspiration but does not have a change in voice. Which of the following is the likely reason?", "options": [{"label": "A", "text": "Superior laryngeal nerve injury", "correct": true}, {"label": "B", "text": "Glossopharyngeal nerve injury", "correct": false}, {"label": "C", "text": "Recurrent laryngeal nerve injury", "correct": false}, {"label": "D", "text": "High vagal injury", "correct": false}], "correct_answer": "A. Superior laryngeal nerve injury", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Superior laryngeal nerve inju\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following conditions does the Gelles test yield a negative result?", "options": [{"label": "A", "text": "CSOM with Cholsteatoma", "correct": false}, {"label": "B", "text": "Senile deafness", "correct": false}, {"label": "C", "text": "Meniere’s disease", "correct": false}, {"label": "D", "text": "Otosclerosis", "correct": true}], "correct_answer": "D. Otosclerosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - O\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the potential diagnosis for a patient who experiences a sensation of room spinning upon standing up from lying down or turning his head, without any previous episodes of losing consciousness?", "options": [{"label": "A", "text": "Benign paroxysmal positional vertigo", "correct": true}, {"label": "B", "text": "Meniere’s disease", "correct": false}, {"label": "C", "text": "Labyrinithitis", "correct": false}, {"label": "D", "text": "Syncope", "correct": false}], "correct_answer": "A. Benign paroxysmal positional vertigo", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\"&gt;Benign&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\"&gt;paroxysmal&lt;/span&gt; positional vertig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is not the ultimate management approach for refractory vertigo caused by Meniere's disease?", "options": [{"label": "A", "text": "Acetazolamide", "correct": true}, {"label": "B", "text": "Labyrinthectomy", "correct": false}, {"label": "C", "text": "Vestibular neurectomy", "correct": false}, {"label": "D", "text": "Intratympanic gentamicin", "correct": false}], "correct_answer": "A. Acetazolamide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 122 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "The inner ear, or the labyrinth has a central chamber called the vestibule with a spherical and elliptical recess, each accommodating important structures of the membranous labyrinth. What structure does the elliptical recess accommodate?", "options": [{"label": "A", "text": "Saccule", "correct": false}, {"label": "B", "text": "Openings of the semicircular canals", "correct": false}, {"label": "C", "text": "Oval window", "correct": false}, {"label": "D", "text": "Utricle", "correct": true}], "correct_answer": "D. Utricle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2HoP0Gc1ArnArAQ6I0sz1738764294.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zcZUSOh3kuW94iILJ6Y91745051657.mp3", "video": ""}, {"text": "A 35-year-old patient presents with complaints of vertigo and dizziness when turning their head side to side. Upon examination, the nystagmus is horizontal. Which of the following is the most likely stimulated structure?", "options": [{"label": "A", "text": "Superior Semicircular Canal", "correct": false}, {"label": "B", "text": "Lateral Semicircular Canal", "correct": true}, {"label": "C", "text": "Posterior Semicircular Canal", "correct": false}, {"label": "D", "text": "Utricle", "correct": false}], "correct_answer": "B. Lateral Semicircular Canal", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LVU9N4uR302yVLDVRvpH1738764463.png", "https://image.prepladder.com/content/908MMJmtWKMr6YsV7eW31738764491.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Horizontal/Lateral Semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects rotations around the vertical axis;</p>\n<p>produces <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> nystagmus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior/Anterior Semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects anterior-posterior head movements;</p>\n<p>produces <span class=\"customMeta\" data-dictid=\"29a8793eb81692777197fd6c0f70b8\">rotatory</span> nystagmus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects vertical head movements;</p>\n<p>produces vertical nystagmus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Utricle and <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">Saccule</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Responds to <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> <span class=\"customMeta\" data-dictid=\"d8d2fc82be16927771809578048a7f\">acceleration</span> and <span class=\"customMeta\" data-dictid=\"7be129d4bb1692777185fa5706fe88\">deceleration</span> or gravitational pull during head tilts.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zZFJ2zH2RMAEbA0OgZvc1745051863.mp3", "video": ""}, {"text": "A 40-year-old male presents with vertigo, nausea, and vomiting. His vertigo worsens with sudden head movements, and he shows signs of horizontal nystagmus. Which of the following best describes the central vestibular connections responsible for his symptoms?", "options": [{"label": "A", "text": "Vestibular nuclei efferents to the cerebellum provide motion awareness.", "correct": false}, {"label": "B", "text": "The vestibulo-ocular reflex involves CN III, IV, and VI via the MLF.", "correct": true}, {"label": "C", "text": "Vestibulospinal fibers connect directly to the cerebellum for balance.", "correct": false}, {"label": "D", "text": "The autonomic system plays no role in vestibular disorders.", "correct": false}], "correct_answer": "B. The vestibulo-ocular reflex involves CN III, IV, and VI via the MLF.", "question_images": ["https://image.prepladder.com/content/bPpjxlPcx5VAL2fgFYIN1738764582.GIF"], "explanation_images": ["https://image.prepladder.com/content/uVSvCRL7eSCvXhAIDb0q1738764662.png", "https://image.prepladder.com/content/DpWNI7a5dlA4eqMeoXtP1738764690.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vestibular Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formed by central processes of <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> cells in Scarpa’s ganglion, it transmits signals from the <span class=\"customMeta\" data-dictid=\"7732c8e49d169277719171da17de32\">labyrinth</span> to the brain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vestibular Nuclei</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Four in number (superior, medial, lateral, descending) located in the brainstem; integrate inputs from <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> receptors, cerebellum, <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> formation, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vestibulo-ocular <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">Reflex</span> (VOR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mediated by <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> sending <span class=\"customMeta\" data-dictid=\"8833ce72c71692777187014d5585e7\">efferent</span> fibers to <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves III, IV, and VI through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> bundle, stabilizes gaze during head movement.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vestibulospinal Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Efferent fibers from <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> to the motor part of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord coordinate head, neck, and body movements.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cerebellar Connections</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Receives inputs from <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> (vestibulocerebellar fibers) to coordinate balance and maintain body equilibrium.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autonomic Nervous System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Explains nausea, vomiting, sweating, and <span class=\"customMeta\" data-dictid=\"dd5d862f051692777194647422e1c9\">pallor</span> seen in <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> disorders like Ménière’s disease.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JbJ6tpePGWniYSjVs1Ta1745052155.mp3", "video": ""}, {"text": "A 30-year-old patient presents with involuntary oscillatory eye movements, vertigo and hearing loss in the right ear. The nystagmus is horizontal, with a fast phase to the right, more pronounced in darkness and improves when focusing on a fixed point. There is no associated nausea or vomiting. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Central vestibular nystagmus due to a cerebellar lesion", "correct": false}, {"label": "B", "text": "Peripheral vestibular nystagmus due to serous labyrinthitis", "correct": true}, {"label": "C", "text": "Peripheral vestibular nystagmus due to purulent labyrinthitis", "correct": false}, {"label": "D", "text": "Central vestibular nystagmus due to Arnold-Chiari malformation", "correct": false}], "correct_answer": "B. Peripheral vestibular nystagmus due to serous labyrinthitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:0px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral Nystagmus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central Nystagmus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location of lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Labyrinth or <span class=\"customMeta\" data-dictid=\"b774537d0c1692777201dee32072fe\">vestibulocochlear</span> (VIII) nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Central <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> pathways (vestibular nuclei, brainstem, cerebellum)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Latency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-20 seconds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No latency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 1 minute</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 1 minute</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">Nystagmus</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Spontaneous nystagmus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gaze-Evoked Nystagmus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Direction of Nystagmus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixed, towards the undermost ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Change with direction of gaze</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fatigability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fatigable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-fatigable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Response to Visual Fixation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Suppressed by <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> fixation; Worsens in darkness or with <strong>Frenzel glasses</strong> (+20 <span class=\"customMeta\" data-dictid=\"6d9055ec23169277718649687cdc08\">dioptre</span> glasses), both abolishing <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> fixation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cannot be suppressed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Accompanying Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe vertigo</li>\n<li>Loss of hearing in one ear</li>\n<li>Ringing in one or both ears</li>\n<li>Difficulty <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> vision</li>\n<li>Loss of balance</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None or slight:</p>\n<ul>\n<li>Impairment in speech</li>\n<li>Weakness or numbness</li>\n<li>Gait disturbance</li>\n<li>Impairment in vision</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tigmbOIH374Dk86eaz3e1746289602.mp3", "video": ""}, {"text": "Which of the following statements regarding the Fitzgerald-Hallpike manoeuvre is false?", "options": [{"label": "A", "text": "The temperature of the water used for stimulation is 44°C for hot water and 30°C for cold water.", "correct": false}, {"label": "B", "text": "A gap of 8-10 minutes is maintained between the cold and hot water stimulations to avoid cross-contamination of effects.", "correct": false}, {"label": "C", "text": "A normal response to cold water stimulation is horizontal nystagmus towards the ipsilateral side.", "correct": true}, {"label": "D", "text": "The test helps to assess vestibular function and can indicate central pathology if directional preponderance is observed.", "correct": false}], "correct_answer": "C. A normal response to cold water stimulation is horizontal nystagmus towards the ipsilateral side.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:673px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Induces <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> by <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> system; tests each <span class=\"customMeta\" data-dictid=\"7732c8e49d169277719171da17de32\">labyrinth</span> separately. Assesses if <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> by the test is similar to the patient's episodes, indicating <span class=\"customMeta\" data-dictid=\"4c41e52057169277719199abf55761\">labyrinthine</span> origin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Kobrak Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Procedure</strong>: Patient seated with head tilted 60° back. Ear irrigated with ice water (5, 10, 20, 40 mL) for 60 s.</li>\n<li><strong>Normal Response</strong>: <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">Nystagmus</span> towards the opposite ear with 5 mL.</li>\n<li><strong>Hypoactive Labyrinth</strong>: Response with increased volumes of water.</li>\n<li><strong>Dead Labyrinth</strong>: No response to 40 mL</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fitzgerald-Hallpike Test (Bithermal <span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\">Caloric</span> Test)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Procedure</strong>: Patient <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> with head tilted 30° forward. Ears irrigated alternately with water at 30°C and 44°C for 40 s each.</li>\n<li><strong>Observation</strong>: Record time taken from <strong>start of irrigation</strong> to<strong> end of nystagmus</strong>; chart on a <strong>calorigram. </strong></li>\n<li><strong>Re-test</strong>: With water at 20°C if no <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> is seen.</li>\n<li><strong>Observation: </strong>Cold water causes <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> to the opposite side and warm water to the same side.</li>\n<li><strong>Assessment</strong>:\n\t\t\t\t<ul>\n<li><strong>Canal Paresis</strong>: Weaker response from one side compared to the other.</li>\n<li><strong>Directional Preponderance</strong>: <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">Nystagmus</span> is more on one side than the other, 25%-30% or more difference.<strong> Occurs towards the side of a <span class=\"customMeta\" data-dictid=\"eb17a790b816927771845aadc7aff2\">central lesion</span> </strong>and away from the side of a <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> lesion.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cold-Air <span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\">Caloric</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Procedure</strong>: Cold air is blown into the ear via a Dundas Grant tube cooled by <span class=\"customMeta\" data-dictid=\"4331e1dd521692777187b06284eb2e\">ethyl</span> chloride.</li>\n<li><strong>Use</strong>: For cases with <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> perforation.</li>\n<li><strong>Type</strong>: Rough <span class=\"customMeta\" data-dictid=\"1304db17d3169277719684a316a8c4\">qualitative</span> test.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9jwKeq1FFfdr84TzgMEH1745052638.mp3", "video": ""}, {"text": "While assessing a patient’s vestibular function, an ENT surgeon repeatedly presses and releases the tragus of the patient, eliciting a positive response. What would this finding indicate?", "options": [{"label": "A", "text": "Cholesteatoma covering the fistula", "correct": false}, {"label": "B", "text": "Perilymph fistula", "correct": true}, {"label": "C", "text": "Intact bony labyrinth", "correct": false}, {"label": "D", "text": "Dead labyrinth", "correct": false}], "correct_answer": "B. Perilymph fistula", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To Assess the integrity of the <span class=\"customMeta\" data-dictid=\"8f50a352d71692777183234f97f2dd\">bony labyrinth</span> and detect <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> fistulas (abnormal openings in the bony labyrinth)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Principle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pressure changes in the <span class=\"customMeta\" data-dictid=\"b9a0fc0e19169277718759be7a9732\">external ear</span> <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> can be transmitted to the <span class=\"customMeta\" data-dictid=\"a1b8deb0fe1692777190df5ce46525\">inner ear</span> through a fistula, triggering vestibulo-ocular <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (VOR), resulting in <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> and possibly vertigo</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pressure Application:</strong> <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">Intermittent</span> pressure applied on the <span class=\"customMeta\" data-dictid=\"e8a77282b816927772006578f87e08\">tragus</span> or using a Siegel's speculum.</li>\n<li><strong>Observation:</strong> Eyes are observed for <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> and the patient is queried about vertigo.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Interpretation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Positive <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">Fistula</span> Test:</strong>\n<ul>\n<li>Indicates a <span class=\"customMeta\" data-dictid=\"7a6af637471692777195f6d6f14afd\">perilymph</span> fistula</li>\n<li>Nystagmus direction helps locate the fistula</li>\n<li>Indicates a functional labyrinth</li>\n</ul>\n</li>\n<li><strong>Negative <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">Fistula</span> Test:</strong>\n<ul>\n<li>Usually indicates intact bony labyrinth</li>\n<li>False negatives can occur if covered by cholesteatoma</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Positive test causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Erosion of <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> semicircular canals as in cholesteatoma</li>\n<li>Surgically created window in <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> canal</li>\n<li>Superior <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> dehiscence</li>\n<li>Abnormal opening in the <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> or round window</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Negative test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No fistula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>False-negative causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgically confirmed cases of <span class=\"customMeta\" data-dictid=\"4c41e52057169277719199abf55761\">labyrinthine</span> fistula</li>\n<li>Cholesteatoma covers the site of fistula</li>\n<li>Dead labyrinth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>False-Positive (Hennebert's Sign)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hennebert's Sign:</strong> Positive test without a fistula; can occur in:</p>\n<ul>\n<li><strong>Congenital Syphilis:</strong> Hypermobile <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate.</li>\n<li><strong>Ménière's Disease:</strong> Due to a distended <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> lying against the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> footplate.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gK1QyJgwhWbrv8SEa4kF1745052864.mp3", "video": ""}, {"text": "A 30-year-old woman is being evaluated in the ENT clinic for vertigo when she gets up from bed. Which of the following tests would be useful for diagnosing benign paroxysmal positional vertigo?", "options": [{"label": "A", "text": "Dix-Hallpike test", "correct": true}, {"label": "B", "text": "Baranay’s rotational chair test", "correct": false}, {"label": "C", "text": "Galvanic test", "correct": false}, {"label": "D", "text": "Dundas Grant test", "correct": false}], "correct_answer": "A. Dix-Hallpike test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/drjnp9Cya0aQL9X65B1B1738764763.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Hfck2q4akzkAw3z1Yxrx1745129603.mp3", "video": ""}, {"text": "Which of the following statements is false about vestibular evoked myogenic potentials?", "options": [{"label": "A", "text": "The cervical VEMP is picked up in the sternocleidomastoid", "correct": false}, {"label": "B", "text": "The vestibulospinal arc mediates through the lower brainstem", "correct": false}, {"label": "C", "text": "The ocular muscle that show potentials are the inferior oblique and inferior rectus", "correct": true}, {"label": "D", "text": "It can be used in diagnosing the origin of a neuroma", "correct": false}], "correct_answer": "C. The ocular muscle that show potentials are the inferior oblique and inferior rectus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/trarI7rVOL1Z0ZR19gaY1738764819.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>cVEMP (Cervical VEMP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>oVEMP (Ocular VEMP)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Target muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sternocleidomastoid (SCM) muscle in the neck</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ocular muscles (inferior <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> or superior rectus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Nerve pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Saccule → <strong>Inferior <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nerve </strong>→ <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> → <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> vestibulospinal <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> → <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> nerve (CN XI) → SCM</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Utricle → <strong>Superior <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nerve</strong> → <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> → <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> <span class=\"customMeta\" data-dictid=\"6f06ed0fab169277720273078a8258\">fasciculus</span> → <span class=\"customMeta\" data-dictid=\"ae7e8fa7d31692777194e3d4325f6b\">Oculomotor</span> nerve (CN III) → <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> and superior <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Stimulation </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily, air-conducted sounds stimulate the saccule</li>\n<li>Bone-conducted sounds, stimulating both <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> and utricle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Clinical uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assessing <span class=\"customMeta\" data-dictid=\"df4e8e3ae81692777198a0513bc88c\">saccular</span> function</li>\n<li>Investigating <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">neuroma</span> (inferior <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nerve)</li>\n<li>Diagnosing Ménière's disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assessing <span class=\"customMeta\" data-dictid=\"264770e96216927772018d98853315\">utricular</span> function</li>\n<li>Investigating <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> <span class=\"customMeta\" data-dictid=\"11117a474a1692777193044082d47a\">neuroma</span> (superior <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nerve)</li>\n<li>Diagnosing superior <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> dehiscence</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Differences </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sensitive to air-conducted sounds</li>\n<li>Vestibulospinal <span class=\"customMeta\" data-dictid=\"2207398c591692777182d7ac096dbc\">arc</span> is mediated through the lower brain stem</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Responds to both air and bone conduction</li>\n<li>Vestibulo-ocular <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> is mediated through the upper brainstem</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WmJ8JhCUkbE7GJI0A3Qf1745130932.mp3", "video": ""}, {"text": "A 45-year-old patient presents with sudden-onset vertigo and difficulty maintaining gaze stability during head movements. Which of the following tests is most appropriate to assess vestibulo-ocular reflex?", "options": [{"label": "A", "text": "Supine Roll Test", "correct": false}, {"label": "B", "text": "Romberg Test", "correct": false}, {"label": "C", "text": "Head Impulse Test", "correct": true}, {"label": "D", "text": "Unterberger Test", "correct": false}], "correct_answer": "C. Head Impulse Test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vHNWwzFsp7TmeX5zm2ha1738764952.png", "https://image.prepladder.com/content/imWMXb7fpeD4d7Lf31sx1738764996.png", "https://image.prepladder.com/content/0P4gUbsOaXN8Y1wfpIHO1738765041.png", "https://image.prepladder.com/content/aEFCrrYOa53uKYtO5QnZ1738765107.png", "https://image.prepladder.com/content/q5sUjyxUN5aup6fcaTon1738765149.png", "https://image.prepladder.com/content/98atQlAiFdDDsE2gbfQG1738765187.png", "https://image.prepladder.com/content/3dICfiK6b0mqlyYyQjjd1738765360.png", "https://image.prepladder.com/content/IpOHQVdsG4GpCJqZcN971738765229.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spontaneous nystagmus</li>\n<li>Fistula test</li>\n<li>Romberg test</li>\n<li>Gait</li>\n<li>Post-Pointing and Falling</li>\n<li>Dix-Hallpike <span class=\"customMeta\" data-dictid=\"220efc126c169277719138aa9a5537\">Maneuver</span> (Positional Test)</li>\n<li>Tests of cerebellar dysfunction</li>\n<li>Head <span class=\"customMeta\" data-dictid=\"00435dfd7d16927772003372024ddb\">thrust</span> test</li>\n<li>Supine roll test</li>\n<li>Unterberger test (Fukuda stepping test)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caloric test</li>\n<li>Electronystagmography</li>\n<li>Optokinetic test</li>\n<li>Rotation test</li>\n<li>Galvanic test</li>\n<li>Posturography</li>\n<li>Dynamic visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> test</li>\n<li>Vestibular-evoked <span class=\"customMeta\" data-dictid=\"980faf3e421692777193c21d55f72f\">myogenic</span> potentials (VEMP)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8NohF61uaCPydPPQVeKx1745131543.mp3", "video": ""}, {"text": "A 56-year-old woman comes to the ENT department complaining of vertigo. She also has double vision, with nystagmus and difficulty in swallowing but no hearing loss . Which of the following disorders could be a cause of these symptoms?", "options": [{"label": "A", "text": "Peripheral vestibular disorders", "correct": false}, {"label": "B", "text": "Central vestibular disorders", "correct": true}, {"label": "C", "text": "Ocular vertigo", "correct": false}, {"label": "D", "text": "Psychogenic vertigo", "correct": false}], "correct_answer": "B. Central vestibular disorders", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> Disorders</strong><strong> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> Disorders</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inner ear or <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nerve (cranial nerve VIII)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brainstem, cerebellum, or other central nervous system structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ménière's Disease</li>\n<li>Benign <span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\">Paroxysmal</span> <span class=\"customMeta\" data-dictid=\"f6c8a9e7f81692777196b0377835ef\">Positional Vertigo</span> (BPPV)</li>\n<li>Vestibular Neuronitis</li>\n<li>Labyrinthitis</li>\n<li>Vestibulotoxic Drugs</li>\n<li>Head Trauma</li>\n<li>Perilymph Fistula</li>\n<li>Acoustic Neuroma</li>\n<li>Syphilis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vertebrobasilar Insufficiency</li>\n<li>Posteroinferior Cerebellar <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (PICA) Syndrome(Wallenberg syndrome)</li>\n<li>Basilar Migraine</li>\n<li>Cerebellar Disease</li>\n<li>Multiple Sclerosis</li>\n<li>Tumors of the <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">Brainstem</span> and Cerebellum</li>\n<li>Epilepsy</li>\n<li>Cervical vertigo</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertigo, often with hearing loss, tinnitus, and aural fullness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertigo, often with additional neurological symptoms like double vision, difficulty swallowing, drop attacks, or weakness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Hearing Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common, especially with <span class=\"customMeta\" data-dictid=\"a1b8deb0fe1692777190df5ce46525\">inner ear</span> disorders (e.g., Ménière's disease, labyrinthitis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less common, central disorders typically do not affect hearing directly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Nystagmus Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often changes direction based on gaze; typically intermittent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be direction-fixed or more persistent; often associated with other neurological signs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Compensation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often improves over time as the brain adapts; recovery can be expected</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less predictable; central disorders may not fully compensate, leading to chronic symptoms</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7W5AgugMONl7OqlOrt4h1745998384.mp3", "video": ""}, {"text": "A 45-year-old male presents with recurrent episodes of severe vertigo, fluctuating sensorineural hearing loss, tinnitus, and a sensation of fullness in the left ear. An Audiogram is taken and is shown below. Which of the following structures is primarily involved in the pathophysiology of the diagnosis?", "options": [{"label": "A", "text": "Semicircular canals", "correct": false}, {"label": "B", "text": "Endolymphatic sac", "correct": true}, {"label": "C", "text": "Stapes footplate", "correct": false}, {"label": "D", "text": "Scala vestibuli", "correct": false}], "correct_answer": "B. Endolymphatic sac", "question_images": ["https://image.prepladder.com/notes/cgXYHCyCAqBuXl7d5YcN1746082863.png"], "explanation_images": ["https://image.prepladder.com/content/LZZ2AIptK5M3PGGfO8tI1738765611.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Role in Ménière's Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endolymphatic sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dysfunction causes <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of endolymph, leading to endolymphatic hydrops, which results in vertigo, tinnitus, hearing loss, and aural fullness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cochlear <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (scala media)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distension of the cochlear <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> affects hearing, leading to <strong>sensorineural hearing loss</strong>. It is the primary site affected in the <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> portion of the inner ear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Saccule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distended <span class=\"customMeta\" data-dictid=\"cf55d6288816927771984bec8dd6df\">saccule</span> may press against the <strong>stapes footplate</strong>, potentially contributing to <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> symptoms and <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> in the advanced stages of the disease. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Semicircular canals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary involvement</strong><strong> </strong>causes <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> symptoms such as <strong>vertigo</strong>, but they are not the primary site of the <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> in Ménière’s disease. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reissner membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>In severe cases</strong>, the bulging of this <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> can result in <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> into the <strong>scala vestibuli</strong>, worsening the symptoms of <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> and hearing loss. <strong>(Option D) </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qgQUJzXOZFYxUoy7dbS01745998674.mp3", "video": ""}, {"text": "A 55-year-old woman experiences brief vertigo when turning in bed. A test is performed as shown below, and horizontal nystagmus is observed. Which of the following tests was performed?", "options": [{"label": "A", "text": "Head impulse test", "correct": false}, {"label": "B", "text": "Dix-Hallpike maneuver", "correct": false}, {"label": "C", "text": "Supine roll test", "correct": true}, {"label": "D", "text": "Epley maneuver", "correct": false}], "correct_answer": "C. Supine roll test", "question_images": ["https://image.prepladder.com/notes/4LMyvSEEBrPuouY3pLkx1746070054.png"], "explanation_images": ["https://image.prepladder.com/content/iP5kA0YAoSivxKJ9h2fo1738805055.png", "https://image.prepladder.com/content/cIvGbTBRln2i9FUiNn9K1738805220.png", "https://image.prepladder.com/content/N6sV9dnMujq878qMzZq81738805404.png", "https://image.prepladder.com/content/NpGrSdlYKkjePBlbqDNi1738805254.png", "https://image.prepladder.com/content/eBAstlovND7VmYA8Euh81738805323.png", "https://image.prepladder.com/content/uqibAedQoZ2a8AUvZ6Pb1738805494.png", "https://image.prepladder.com/content/RQVvkReNvLEoLC9tURpd1738805603.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:630px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benign Paroxysmal Positional <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">Vertigo</span> (BPPV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by specific head positions, such as reaching for something overhead.</li>\n<li>Most common type of <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> vertigo</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M/c <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> &gt; <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">Horizontal</span> semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> &gt; Anterior semicircular canal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Head trauma (M/c cause)</li>\n<li>Vestibular neuritis</li>\n<li>Otosclerosis</li>\n<li>Meniere’s disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Otoconia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcium <span class=\"customMeta\" data-dictid=\"fdae4d6e3a1692777183b5745d0c02\">carbonate</span> crystals embedded in the <span class=\"customMeta\" data-dictid=\"948746a830169277719140f9f93879\">macula</span> of the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> and saccule.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Displaced <span class=\"customMeta\" data-dictid=\"9964c22ac2169277719410824f55e6\">otolith</span> from the <span class=\"customMeta\" data-dictid=\"8612f222fd16927772018800e69a12\">utricle</span> stimulates <span class=\"customMeta\" data-dictid=\"3f7f88334c169277718520001a0b25\">cupula</span> of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> causing <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> and nystagmus.</li>\n<li>Changes in head position with gravity lead to <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"3f7f88334c169277718520001a0b25\">cupula</span> in the affected semicircular canal, stimulating <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> afferents.</li>\n<li>This results in characteristic <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> eye movements and vertigo.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"220\" src=\"https://image.prepladder.com/content/iP5kA0YAoSivxKJ9h2fo1738805055.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Episodic <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> lasting for seconds</li>\n<li>Positional vertigo: Imbalance on lying down, sitting up from a lying position, or rolling in bed or when flexing the neck.</li>\n<li>Vertigo (fatigable) may resolve temporarily but can recur after a period of rest.</li>\n<li>± Nausea, vomiting</li>\n<li>No hearing loss</li>\n<li>No neurologic symptoms</li>\n<li>No tinnitus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic Test </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dix-Hallpike Maneuver</strong><strong> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supine Roll Test </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"777\" src=\"https://image.prepladder.com/content/cIvGbTBRln2i9FUiNn9K1738805220.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"572\" src=\"https://image.prepladder.com/content/N6sV9dnMujq878qMzZq81738805404.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/NpGrSdlYKkjePBlbqDNi1738805254.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/eBAstlovND7VmYA8Euh81738805323.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Canal tested </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> (P-SCC) &gt; Anterior semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> (A-SCC)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Horizontal semicircular canal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nystagmus </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Towards affected side</li>\n<li>Upbeating torsional <span class=\"customMeta\" data-dictid=\"b105951ae61692777188cc596ca745\">geotropic</span> nystagmus: P-SCC affected</li>\n<li>Downbeating <span class=\"customMeta\" data-dictid=\"b105951ae61692777188cc596ca745\">geotropic</span> torsional nystagmus: A-SCC affected</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Horizontal <span class=\"customMeta\" data-dictid=\"b105951ae61692777188cc596ca745\">geotropic</span> <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> towards the affected side</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Tx56ggntLGQVKCotfzIv1745999032.mp3", "video": ""}, {"text": "A 55-year-old woman with vertigo triggered by head position changes is diagnosed with posterior semicircular canal (P-SCC) BPPV. Which of the following maneuvers is not used primarily for treating P-SCC BPPV?", "options": [{"label": "A", "text": "Epley maneuver", "correct": false}, {"label": "B", "text": "Semont maneuver", "correct": false}, {"label": "C", "text": "Brandt-Daroff exercises", "correct": false}, {"label": "D", "text": "Gufoni maneuver", "correct": true}], "correct_answer": "D. Gufoni maneuver", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/H7bZA9n6nBk0LCbzPcmB1738805797.png", "https://image.prepladder.com/content/pG0Q0uUlzsurFKnusFax1738805834.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> BPPV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Horizontal Semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> BPPV</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Epley’s <span class=\"customMeta\" data-dictid=\"220efc126c169277719138aa9a5537\">maneuver</span> (best) <strong>(Option A)</strong></li>\n<li>Semont’s liberatory <span class=\"customMeta\" data-dictid=\"220efc126c169277719138aa9a5537\">maneuver</span> <strong>(Option B)</strong></li>\n<li>Brandt-Daroff positional exercises <strong>(Option C)</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Forced prolonged position on the healthy side</li>\n<li>270° Barbecue maneuver</li>\n<li>360° <span class=\"customMeta\" data-dictid=\"e790ad5b0b1692777202abfc4fa091\">Yaw</span> rotation</li>\n<li>Liberatory maneuver</li>\n<li>Gufoni maneuver</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9kHyyLFNLjoy9RwIIilG1745999234.mp3", "video": ""}, {"text": "A 45-year-old male presents with acute onset of severe vertigo, nausea, and vomiting that has been persistent for the last 24 hours. He has right horizontal nystagmus that worsens with head movement. His hearing is normal, and there are no signs of weakness or dysarthria. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Vestibular neuritis", "correct": true}, {"label": "B", "text": "Cerebellar stroke", "correct": false}, {"label": "C", "text": "Ménière’s disease", "correct": false}, {"label": "D", "text": "Benign paroxysmal positional vertigo (BPPV)", "correct": false}], "correct_answer": "A. Vestibular neuritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammation of the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> nerve, commonly due to <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infection (e.g., <span class=\"customMeta\" data-dictid=\"eee52fe3cc16927771970c8dffdfd2\">reactivation</span> of HSV). Other causes include <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> and <span class=\"customMeta\" data-dictid=\"fced475d231692777189effb72c5c7\">immunologic</span> origins.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vestibular portion of the CN VIII, primarily affecting the superior portion of the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> labyrinth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertigo</strong></p>\n<p><strong>Nausea/Vomiting</strong></p>\n<p><strong>Balance issues</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antiemetics</strong> (promethazine, metoclopramide)</p>\n<p><strong>Antihistamines</strong> (meclizine, diphenhydramine)</p>\n<p><strong>Benzodiazepines</strong> (diazepam, lorazepam)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peripheral <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">Vertigo</span> (e.g., <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">Vestibular</span> Neuritis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Central <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">Vertigo</span> (e.g., Cerebellar Stroke)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset of Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden, constant vertigo</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden or gradual; can be constant or episodic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nystagmus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unidirectional, worsens with gaze in the direction of fast component</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multidirectional or vertical, may change direction with gaze</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hearing Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal (in <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> neuritis); Ménière’s involves hearing loss</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No hearing involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (e.g., dysarthria, incoordination, limb weakness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration of Vertigo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Days to weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable, may persist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Head Movement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Worsens symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often no impact</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vestibular neuritis, BPPV, Ménière’s disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cerebellar stroke, multiple sclerosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LDDXRSuw9DWUiZmQAvgO1745999940.mp3", "video": ""}, {"text": "A 12-year-old child with a history of temporal bone abnormalities presents with recurrent episodes of vertigo, fluctuating hearing loss, and tinnitus. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Meniere’s disease", "correct": false}, {"label": "B", "text": "Perilymph fistula", "correct": true}, {"label": "C", "text": "Vestibular neuritis", "correct": false}, {"label": "D", "text": "Labyrinthitis", "correct": false}], "correct_answer": "B. Perilymph fistula", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can occur after head trauma, <span class=\"customMeta\" data-dictid=\"5b92d758801692777182d17f9d55bc\">barotrauma</span> (e.g., diving), <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone anomalies, or ear surgery (e.g., stapedectomy).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluctuating <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> hearing loss, vertigo, tinnitus, and sometimes a sense of fullness in the ear.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> (especially in children with <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone defects), <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) leak.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often clinical, based on history and symptoms; confirmed through <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> exploration if suspected.</p>\n<p><strong>Temporal bone CT:</strong> Shows pneumolabyrinth, accumulation of fluid in the middle ear, and/or <span class=\"customMeta\" data-dictid=\"22d574e4221692777194933e257251\">ossicular chain</span> disruption, but also can often be normal.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> to prevent further complications, such as meningitis; limited improvement in hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hearing improvement post-surgery is usually limited; however, <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> symptoms often improve or resolve.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/h5AKE7wruFCdYzbkGh641746289818.mp3", "video": ""}, {"text": "A 45-year-old man presents with intermittent vertigo, hearing his footsteps loudly and a sensation of fullness in his ear. He experiences vertigo triggered by loud noises and changes in pressure, but there is no history of recent infection or trauma. An audiogram is done, and it suggests Mixed hearing loss. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Superior Semicircular Canal Dehiscence (SSCD)", "correct": true}, {"label": "B", "text": "Labyrinthitis", "correct": false}, {"label": "C", "text": "Ménière's Disease", "correct": false}, {"label": "D", "text": "Vestibular Neuronitis", "correct": false}], "correct_answer": "A. Superior Semicircular Canal Dehiscence (SSCD)", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hearing Loss Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertigo Trigger</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior Semicircular <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">Dehiscence</span> (SSCD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loud sounds, pressure changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autophony, <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> tinnitus, air-bone gap, Tullio phenomenon, third window effect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Labyrinthitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensorineural</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous, after infection</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute onset, post-viral/bacterial, <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> with hearing loss, no CHL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ménière's Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensorineural</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous, episodic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Episodic vertigo, aural fullness, tinnitus, fluctuating hearing loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vestibular Neuronitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden onset, spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden vertigo, no hearing loss, likely <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> etiology, resolves in days to weeks</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CDVB2jOnJMknz5hqbC7V1746545117.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 3 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Identify the surgical instrument depicted in the provided image.", "options": [{"label": "A", "text": "Mixter Forceps", "correct": true}, {"label": "B", "text": "Rampley Forceps", "correct": false}, {"label": "C", "text": "Kocher Forceps", "correct": false}, {"label": "D", "text": "Adson Forceps", "correct": false}], "correct_answer": "A. Mixter Forceps", "question_images": ["https://image.prepladder.com/content/N9W4rOyljstx82uuspc21745932697.png"], "explanation_images": ["https://image.prepladder.com/content/j7xEz9QJls97VhH6gzY11745212141.png", "https://image.prepladder.com/content/DPUoQttnEj15w3D2XkTr1745212148.png", "https://image.prepladder.com/content/opnbBAYvPAzQMlpAq1Sx1745212155.png", "https://image.prepladder.com/content/vOWEqGTtLdKqbIghqJxj1745932836.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rampley's <span class=\"customMeta\" data-dictid=\"1f8d123d5a16927771996d6f75145f\">Sponge</span> Holding Forceps</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"410\" src=\"https://image.prepladder.com/content/j7xEz9QJls97VhH6gzY11745212141.png\" width=\"410\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Designed in a scissor-like configuration, featuring ratcheted handles with <strong>serrated looped jaws</strong>.</li>\n<li>Used to handle <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> or sponges.</li>\n<li>Used to hold <span class=\"customMeta\" data-dictid=\"bec5d0b8cb1692777188267d64974a\">gall</span> bladder/cervix/tongue etc., during <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> procedures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kocher’s Forceps</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Josephine Bitat\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pince_Kocher_-_mus%C3%A9e_HCL_-_instruments_chirurgicaux.jpg\" data-tags=\"\" height=\"232\" src=\"https://image.prepladder.com/content/DPUoQttnEj15w3D2XkTr1745212148.png\" width=\"410\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Serrations in the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> blades with an opposing tooth at the tip.</li>\n<li>Holds tissues or pedicles securely, preventing slippage and <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> of vessels or bleeders.</li>\n<li>Types:\n\t\t\t\t<ul>\n<li>Straight/Curved.</li>\n<li>Small/medium/large.</li>\n</ul>\n</li>\n<li>Used in <strong>thyroidectomy, hemorrhoidectomy, mastectomy, polypectomy, and hysterectomy</strong>.</li>\n<li>Used to secure tough or <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissues in areas like the palms, soles, and <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> to prevent vessel <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> during surgery.</li>\n<li>Holds <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> and <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> pellets.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toothed Forceps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"410\" src=\"https://image.prepladder.com/content/opnbBAYvPAzQMlpAq1Sx1745212155.png\" width=\"410\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to hold skin and tough structures like <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> and aponeurosis.</li>\n<li>Not used for delicate structures like the bowel, vessels, or nerves.</li>\n<li>May have one-in-two or two-in-three teeth.</li>\n<li><strong>Adson’s <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">Forceps</span> </strong><strong>(Option D)</strong>: Small, fine <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> for delicate work; can be toothed or non-toothed.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"744\" src=\"https://image.prepladder.com/content/vOWEqGTtLdKqbIghqJxj1745932836.png\" width=\"1999\"/></p>\n<p> </p>\n<ul>\n<li><strong>Victor–Bonney’s Forceps</strong>: Heavy-toothed dissecting forceps.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the instrument provided.", "options": [{"label": "A", "text": "Linear stapler", "correct": true}, {"label": "B", "text": "Skin stapler", "correct": false}, {"label": "C", "text": "Circular stapler", "correct": false}, {"label": "D", "text": "Curved stapler", "correct": false}], "correct_answer": "A. Linear stapler", "question_images": ["https://image.prepladder.com/notes/xdAzI44TSejZQig9VzH61747400843.png"], "explanation_images": ["https://image.prepladder.com/notes/e9Hts3IplcbamH3gvf3Q1747382931.png", "https://image.prepladder.com/notes/ys81WcK211qGlSNSDx1Q1747383038.png", "https://image.prepladder.com/notes/NiT9wjanz88th8kiFYwQ1747407757.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are used to stop oesophagal variceal bleeding?", "options": [{"label": "A", "text": "A, B &amp;amp; C", "correct": true}, {"label": "B", "text": "A and B only", "correct": false}, {"label": "C", "text": "A, Band C", "correct": false}, {"label": "D", "text": "A, B and D", "correct": false}], "correct_answer": "A. A, B &amp; C", "question_images": ["https://image.prepladder.com/notes/P8XI59f8YDLmEHwJoDa41746518124.png"], "explanation_images": ["https://image.prepladder.com/notes/OH0zdarcbW7eghN8WlkP1746518275.png", "https://image.prepladder.com/notes/gpgzVXqTdDtBFimBX5hi1746518302.png", "https://image.prepladder.com/notes/0kO3dRU25atHMnqR4Dc71746518329.png", "https://image.prepladder.com/notes/ZDPs59o2KHn84OjK8h0y1746518359.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 13 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 18 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 60-year-old male with a history of persistent hoarseness, throat pain, and difficulty swallowing was recently diagnosed with Laryngeal Carcinoma. Which of the following is not a known risk factor for developing laryngeal cancer in this patient?", "options": [{"label": "A", "text": "Heavy smoking and alcohol consumption", "correct": false}, {"label": "B", "text": "Genetic predisposition due to Fanconi anemia", "correct": false}, {"label": "C", "text": "Exposure to coal dust", "correct": false}, {"label": "D", "text": "Exposure to EBV", "correct": true}], "correct_answer": "D. Exposure to EBV", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Uzgr5RpaOLxdRDahqYc11743407156.mp3", "video": ""}, {"text": "A 58-year-old male presents with progressive hoarseness of voice and mild dyspnea on exertion. He underwent coronary artery bypass grafting 6 months ago. A fiberoptic laryngoscopy reveals left-sided vocal cord paralysis in the paramedian position. A chest CT scan shows no mediastinal mass or aortic enlargement. Electromyography of the laryngeal muscles reveals denervation. What is the most likely cause of his vocal cord paralysis?", "options": [{"label": "A", "text": "Left atrial enlargement due to mitral valve disease", "correct": false}, {"label": "B", "text": "Post-surgical trauma to the recurrent laryngeal nerve (RLN)", "correct": true}, {"label": "C", "text": "Compression of the recurrent laryngeal nerve by aortic aneurysm", "correct": false}, {"label": "D", "text": "Idiopathic unilateral vocal cord paralysis", "correct": false}], "correct_answer": "B. Post-surgical trauma to the recurrent laryngeal nerve (RLN)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:536px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cervical surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thyroidectomy/parathyroidectomy</li>\n<li>Carotid endarterectomy</li>\n<li>Anterior approach to the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine</li>\n<li>Repair Zenker’s diverticulum</li>\n<li>Cricopharyngeal myotomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thoracic procedures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thoracic <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> repair</li>\n<li>Pneumonectomy</li>\n<li>Aortic <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> repair</li>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> grafting</li>\n<li>Esophageal or <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> surgery</li>\n<li>Mediastinoscopy</li>\n<li>Ligation of patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Others</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Skull base or <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> surgery</li>\n<li>Endotracheal intubation</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aetoZI1QHr2z8DhUaxzD1743572134.mp3", "video": ""}, {"text": "In a patient who has undergone a total laryngectomy, a portable vocal rehabilitation device needs to be prescribed immediately post-surgery. Choose the device from the given options:", "options": [{"label": "A", "text": "Electrolarynx", "correct": true}, {"label": "B", "text": "Transoral pneumatic device", "correct": false}, {"label": "C", "text": "Blom-Singer or Panje prosthesis", "correct": false}, {"label": "D", "text": "Esophageal speech", "correct": false}], "correct_answer": "A. Electrolarynx", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mMsnscw3Niim14By5cFp1738576745.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1O1Fdxk0U0igzEedidhJ1743572383.mp3", "video": ""}, {"text": "In a patient diagnosed with stage 3 laryngeal carcinoma with no involvement of thyroid cartilage, the patient is unwilling to undergo chemoradiotherapy. What will be the treatment of choice in this case?", "options": [{"label": "A", "text": "Total laryngectomy", "correct": true}, {"label": "B", "text": "Conservative Surgery", "correct": false}, {"label": "C", "text": "Micro laryngeal surgery", "correct": false}, {"label": "D", "text": "Vertical hemilaryngectomy", "correct": false}], "correct_answer": "A. Total laryngectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WJmWY2zYGvlORQmluvra1743576425.mp3", "video": ""}, {"text": "A 55-year-old patient is diagnosed with glottic carcinoma involving the right side of the vocal cord. The tumor extends to the supraglottis with impaired vocal cord mobility. What is the most appropriate primary treatment for this patient?", "options": [{"label": "A", "text": "Total laryngectomy", "correct": false}, {"label": "B", "text": "Radiotherapy", "correct": false}, {"label": "C", "text": "Endoscopic CO2 laser excision", "correct": false}, {"label": "D", "text": "Vertical hemilaryngectomy", "correct": true}], "correct_answer": "D. Vertical hemilaryngectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TNM Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage Grouping</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">T1N0M0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Stage I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glottic- </strong>Radiotherapy or Endoscopic CO2 laser resection</p>\n<p><strong>Supraglottic-</strong> <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">Radiotherapy</span> or Endoscopic CO2 laser resection</p>\n<p><strong>Subglottic-</strong> Radiotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">T2N0M0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Stage II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glottic-</strong></p>\n<ul>\n<li>Radiotherapy- when the cord is mobile</li>\n<li>Vertical hemilaryngectomy- when cord <span class=\"customMeta\" data-dictid=\"650eb29fb9169277719270ea0fbea5\">mobility</span> is impaired <strong>or </strong>Involvement of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> commissure/arytenoid</li>\n</ul>\n<p><strong>Supraglottic- </strong></p>\n<ul>\n<li>Supraglottic <span class=\"customMeta\" data-dictid=\"27b41b154c16927771914ee67bd336\">laryngectomy</span> with/without neck dissection- when lung function is good</li>\n<li>Supraglottic <span class=\"customMeta\" data-dictid=\"27b41b154c16927771914ee67bd336\">laryngectomy</span> with/without neck <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> + Radiotherapy- when lung function is poor</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Subglottic- </strong>Radiotherapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tHT4MiDrYbARv1mG3dW31745605214.mp3", "video": ""}, {"text": "A 55-year-old man presents with hoarseness and difficulty swallowing. Laryngoscopy reveals a tumor involving both vocal cords with normal mobility. There is no evidence of spread beyond the larynx or lymph node involvement. Based on the TNM classification of laryngeal carcinoma, what is the most appropriate staging for this patient's condition?", "options": [{"label": "A", "text": "T1a N0", "correct": false}, {"label": "B", "text": "T1b N0", "correct": true}, {"label": "C", "text": "T2 N0", "correct": false}, {"label": "D", "text": "T3 N0", "correct": false}], "correct_answer": "B. T1b N0", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ References:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor is limited to one subsite of <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> with normal vocal cord mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of more than one adjacent subsites of <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> or <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> or region outside the <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> (e.g. <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of base of tongue, vallecula, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of <span class=\"customMeta\" data-dictid=\"7cdb5ed73b16927771966f6c4800de\">pyriform</span> sinus) without <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the larynx.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor is limited to the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space and/or minor <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> invasion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades through the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor limited to vocal cord(s) (may involve <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> commissures) with normal mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor is limited to one vocal cord. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor involves both vocal cords.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor extends to <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> and/or subglottis, and/or with impaired vocal cord mobility. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor is limited to the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> and/or invades paraglottic space and/or minor <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> erosion. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades through <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscles of the tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, thyroid, or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T4b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor is limited to the subglottis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor extends to the vocal cord(s) with normal or impaired mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor limited to <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord fixation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> or <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, 3 cm or less in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, more than 3 cm but not more than 6 cm in greatest dimension, or multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension, or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in the greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> more than 3 cm but not more than 6 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Na</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> more than 6 cm in the greatest dimension</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No Distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VL8qhdqfdT9YzkySyIyT1745604949.mp3", "video": ""}, {"text": "A 58-year-old woman presents with progressive stridor and difficulty breathing for the past 2 months. Laryngoscopy reveals a mass in the subglottic region with normal appearing and mobile vocal cords. Which of the following statements about subglottic carcinoma is incorrect?", "options": [{"label": "A", "text": "Hoarseness is typically a late symptom", "correct": false}, {"label": "B", "text": "Lymphatic spread is common to prelaryngeal and paratracheal nodes", "correct": false}, {"label": "C", "text": "It often presents with airway obstruction as an early symptom", "correct": false}, {"label": "D", "text": "Prognosis is generally better than glottic carcinoma", "correct": true}], "correct_answer": "D. Prognosis is generally better than glottic carcinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Least common site of laryngeal cancer (1-5% of cases)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends from undersurface of vocal cords to lower border of <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vocal cord involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually late; vocal cords often appear normal in early stages</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can spread circumferentially, invade <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> membrane, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland, and trachea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common to prelaryngeal, pretracheal, paratracheal, and lower <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> nodes <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Early:</strong> Stridor, laryngeal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> <strong>(Option C)</strong></p>\n<p><strong>Late:</strong> Hoarseness, cough, <span class=\"customMeta\" data-dictid=\"444cf910041692777188685b347d0f\">hemoptysis</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poorly differentiated</p>\n<p>Predominantly <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally worse than glottic <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> due to late diagnosis and higher rate of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/b5MjGaweJgE1zY6EhEuj1745604806.mp3", "video": ""}, {"text": "A 60-year-old man presents with persistent hoarseness for the past 2 months. Laryngoscopy reveals a small lesion on the anterior third of the right vocal cord with normal cord mobility. Further investigations lead to the diagnosis of Glottic laryngeal carcinoma. Which of the following statements about the condition is incorrect ?", "options": [{"label": "A", "text": "It is the most common site of origin for glottic carcinoma", "correct": false}, {"label": "B", "text": "Hoarseness is typically an early symptom", "correct": false}, {"label": "C", "text": "Lymph node metastases are common in early stages", "correct": true}, {"label": "D", "text": "Histopathologically well differentiated and less malignant", "correct": false}], "correct_answer": "C. Lymph node metastases are common in early stages", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ References:</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common site of laryngeal cancer origin <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Free edge and upper surface of vocal cord, mainly in <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and middle third</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vocal cord involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involvement of vocal cord occurs early so the patient presents <strong>early </strong>with <span class=\"customMeta\" data-dictid=\"4da1fe73a71692777189ec55b7ed8c\">hoarseness</span> of voice <strong>(Option B)</strong></li>\n<li>Vocal cord <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> indicates spread to <span class=\"customMeta\" data-dictid=\"7bc832d5ba169277720012d171cc03\">thyroarytenoid</span> muscle and is a bad <span class=\"customMeta\" data-dictid=\"cfb6c738351692777196f69788a66e\">prognostic</span> sign</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rare due to few lymphatics in vocal cords</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Local Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Can spread locally to <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> commissure, opposite cord, <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> region, ventricle, false cord, and <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> region</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hoarseness is an early sign; <span class=\"customMeta\" data-dictid=\"c8af142f48169277719965c593fa0b\">stridor</span> and laryngeal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> in advanced cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Well differentiated and less <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oNyWDIoUFSHy3oJd9bvd1743576874.mp3", "video": ""}, {"text": "A 58-year-old man presents with dysphagia, throat pain, and a palpable neck mass. Laryngoscopy reveals a lesion on the epiglottis. Further investigations lead to the diagnosis of Laryngeal carcinoma.Which of the following is not a typical characteristic of this condition?", "options": [{"label": "A", "text": "Bilateral lymph node metastases are common but occurs late", "correct": true}, {"label": "B", "text": "Hoarseness is usually a late symptom", "correct": false}, {"label": "C", "text": "The most common histological type is squamous cell carcinoma", "correct": false}, {"label": "D", "text": "It may spread to the pre-epiglottic space", "correct": false}], "correct_answer": "A. Bilateral lymph node metastases are common but occurs late", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less frequent than glottic cancer; about 30-35% of all laryngeal cancers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Majority on epiglottis, false cords, followed by <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> folds</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vocal cord involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually late; vocal cords often spared in early stages</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lymphatic spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early and often bilateral</li>\n<li>Upper and middle <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> nodes commonly involved</li>\n<li>Cancer of <span class=\"customMeta\" data-dictid=\"604985e2361692777190a81eb61544\">infrahyoid</span> <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> &amp; <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> band may extend into pre-epiglottic space <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Early:</strong> Often silent, dysphagia, throat pain</li>\n<li><strong>Late: </strong>Hoarseness, weight loss, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> obstruction, <span class=\"customMeta\" data-dictid=\"47755c9e931692777188e07e343028\">halitosis</span> <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>90-95% <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> <strong>(Option C)</strong></li>\n<li>Others include <span class=\"customMeta\" data-dictid=\"0f0be4ebf11692777201b3aaf5e6fc\">verrucous</span> carcinoma, <span class=\"customMeta\" data-dictid=\"fc5f7fef0e169277719952d19a4532\">spindle</span> cell carcinoma</li>\n<li>Highly anaplastic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally worse than glottic cancer due to:</p>\n<ul>\n<li>Late diagnosis</li>\n<li>High rate &amp; early <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</li>\n<li>Anaplastic nature</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zo11aJBO2GrcbazTLiwG1743407528.mp3", "video": ""}, {"text": "Which of the following statements about the laryngeal nerve supply is incorrect?", "options": [{"label": "A", "text": "The right recurrent laryngeal nerve arises from the vagus at the level of the subclavian artery, while the left recurrent laryngeal nerve arises at the level of the arch of the aorta.", "correct": false}, {"label": "B", "text": "The internal branch of the superior laryngeal nerve provides sensory innervation to the larynx below the vocal cords.", "correct": true}, {"label": "C", "text": "The external branch of the superior laryngeal nerve innervates the cricothyroid muscle.", "correct": false}, {"label": "D", "text": "The left recurrent laryngeal nerve has a longer course than the right, making it more prone to paralysis.", "correct": false}], "correct_answer": "B. The internal branch of the superior laryngeal nerve provides sensory innervation to the larynx below the vocal cords.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pcf8kmVz6QLehSVRmKf11738576017.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Xdu8a8gQA50q917qfPNd1742982323.mp3", "video": ""}, {"text": "During a thyroidectomy, the surgeon encounters difficulty identifying the external branch of the superior laryngeal nerve (EBSLN). To improve nerve visualization, the surgeon decides to explore a specific avascular space between the upper pole of the thyroid gland and the cricothyroid muscle. Which of the following spaces is the surgeon aiming to open to aid in the preservation of the EBSLN?", "options": [{"label": "A", "text": "Reinke’s Space", "correct": false}, {"label": "B", "text": "Reeve’s space", "correct": true}, {"label": "C", "text": "Space of Boyer", "correct": false}, {"label": "D", "text": "Paraglottic Space", "correct": false}], "correct_answer": "B. Reeve’s space", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JxNTEeEYZWPhNjYIg70k1739260581.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GINVyGsj6NEf5aitDf5I1743405778.mp3", "video": ""}, {"text": "Joll’s Triangle is used to identify which of the following nerves?", "options": [{"label": "A", "text": "Recurrent Laryngeal Nerve", "correct": false}, {"label": "B", "text": "External Branch of the Superior Laryngeal Nerve", "correct": true}, {"label": "C", "text": "Internal Branch of the Superior Laryngeal Nerve", "correct": false}, {"label": "D", "text": "Vagus Nerve", "correct": false}], "correct_answer": "B. External Branch of the Superior Laryngeal Nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DQM0fUUuhwRwzKR8XhnG1738576543.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/82PiNlq2MJQgwhwXLvOj1743405576.mp3", "video": ""}, {"text": "Which of the following triangles is not used to identify the recurrent laryngeal nerve?", "options": [{"label": "A", "text": "Joll’s triangle", "correct": true}, {"label": "B", "text": "Simon’s triangle", "correct": false}, {"label": "C", "text": "Beahr’s triangle", "correct": false}, {"label": "D", "text": "Lore’s triangle", "correct": false}], "correct_answer": "A. Joll’s triangle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kr3XbxydMEg0gN69AZWi1739260516.png", "https://image.prepladder.com/content/OC7Tz8pMwpKXkH7MK0SZ1738576483.png", "https://image.prepladder.com/content/offSbuJdLWHNFHpWAMIZ1738576495.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>RLN identification triangles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beahrs <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> (Riddle’s Triangle) </strong><strong>(Option C)</strong></p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1696\" src=\"https://image.prepladder.com/content/kr3XbxydMEg0gN69AZWi1739260516.png\" width=\"1999\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boundaries:\n\t\t\t\t<ul>\n<li>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (base)</li>\n<li>Inferior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (superior)</li>\n<li>Recurrent laryngeal nerve (third side)</li>\n</ul>\n</li>\n<li>Location: <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> to <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> in the <span class=\"customMeta\" data-dictid=\"475476487516927772007d27e8da21\">tracheoesophageal</span> groove.</li>\n<li>Importance: Used to safeguard the <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve during <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> surgery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simon’s <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> </strong><strong>(Option A)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1577\" src=\"https://image.prepladder.com/content/OC7Tz8pMwpKXkH7MK0SZ1738576483.png\" width=\"1999\"/></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boundaries:\n\t\t\t\t<ul>\n<li>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (lateral)</li>\n<li>Esophagus (medial)</li>\n<li>Inferior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (superior)</li>\n</ul>\n</li>\n<li>Importance: RLN crosses the <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> and is identified intraoperatively.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lore’s <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> </strong><strong>(Option D)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1791\" src=\"https://image.prepladder.com/content/offSbuJdLWHNFHpWAMIZ1738576495.png\" width=\"1999\"/></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boundaries:\n\t\t\t\t<ul>\n<li>Trachea/esophagus (medial)</li>\n<li>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (lateral)</li>\n<li>Surface of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> pole of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> (superior)</li>\n</ul>\n</li>\n<li>Importance: Used for identification of the <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recurrent Laryngeal Nerve (RLN) Triangle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Boundaries:\n\t\t\t\t<ul>\n<li>Apex: <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">Thoracic</span> <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> (inferior)</li>\n<li>Medial: Trachea</li>\n<li>Lateral: <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> edge of retracted <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles</li>\n<li>Superior: Lower edge of <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> pole</li>\n</ul>\n</li>\n<li>Importance: RLN exits as a single trunk at the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> inlet.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/h8IwQ5UjTRMdTzabGtFu1743405375.mp3", "video": ""}, {"text": "A 55-year-old male underwent total thyroidectomy for a large multinodular goiter. Postoperatively, he presents with complete loss of voice, frequent aspiration of liquids, and an inability to cough effectively. On laryngoscopy, both vocal cords are found in a cadaveric position, and there is no sensation in the larynx. He is also experiencing difficulty breathing and frequent episodes of bronchopneumonia. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bilateral superior laryngeal nerve paralysis", "correct": false}, {"label": "B", "text": "Bilateral recurrent laryngeal nerve paralysis", "correct": false}, {"label": "C", "text": "Unilateral recurrent and superior laryngeal nerve paralysis", "correct": false}, {"label": "D", "text": "Bilateral recurrent and superior laryngeal nerve paralysis", "correct": true}], "correct_answer": "D. Bilateral recurrent and superior laryngeal nerve paralysis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:620px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Unilateral Combined Paralysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Bilateral Combined Paralysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Affected Nerves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>One side (Recurrent and Superior Laryngeal Nerves)</li>\n<li>Thyroid surgery is the most common cause.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Both sides (Recurrent and Superior Laryngeal Nerves)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vocal Cord Position</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Paralyzed cord in <strong>cadaveric </strong>position (3.5 mm from midline)</li>\n<li>Healthy cord unable to fully <span class=\"customMeta\" data-dictid=\"f3c62587931692777181dabdaa512d\">approximate</span> paralyzed cord</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Both cords in the <strong>cadaveric (Intermediate) position</strong> (neutral, apart from midline)</li>\n<li>Complete lack of movement in both cords</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>All the muscles of the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> on one side are paralyzed except the interarytenoid.</li>\n<li><strong>Hoarseness</strong>: Due to glottic incompetence</li>\n<li><strong>Aspiration</strong>: Liquids pass through the glottis</li>\n<li><strong>Ineffective cough</strong>: Due to air waste from incomplete vocal fold closure</li>\n<li>Mild <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> risk</li>\n<li>Breathing: Usually unaffected as <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> remains adequate</li>\n<li>Speech: Weak or breathy, but functional</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>All the laryngeal muscles are paralyzed.</li>\n<li>Total <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> of the larynx.</li>\n<li><strong>Aphonia</strong>: Complete loss of voice as cords do not meet</li>\n<li><strong>Severe aspiration</strong>: Total glottic incompetence, laryngeal anesthesia</li>\n<li><strong>Inability to cough</strong>: Cords cannot meet to generate pressure for coughing</li>\n<li>Bronchopneumonia: Due to frequent <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> of secretions into the lungs</li>\n<li><strong>Respiratory distress</strong>: Due to compromised <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> and <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> of secretions</li>\n<li><strong>Speech</strong>: Completely absent</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Voice therapy</strong> - for compensation by the healthy cord</li>\n<li><strong>Injection <span class=\"customMeta\" data-dictid=\"ab25dbd10c1692777191430f81c6d9\">laryngoplasty</span> </strong>(temporary or permanent fillers)</li>\n<li><strong>Thyroplasty Type I</strong> with or without <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> adduction</li>\n</ul>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li><strong>Tracheostomy </strong>to clear <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> secretions</li>\n<li><strong>Gastrostomy </strong>to prevent <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> and maintain nutrition</li>\n<li><strong>Epiglottopexy </strong>to prevent aspiration</li>\n<li><strong>Vocal cord plication</strong> to prevent aspiration</li>\n<li><strong>Total laryngectomy</strong> or <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> procedures in severe cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2c4O2aoDqlpey2AUzF791743405019.mp3", "video": ""}, {"text": "A 45-year-old professional singer presents with complaints of vocal fatigue and difficulty producing high-pitched sounds for the last 3 months. She denies any difficulty in swallowing or breathing. On laryngoscopic examination, no significant abnormalities are seen, and one vocal cord appears to be in normal resting position while other vocal cord is in abducted position . What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bilateral SLN palsy", "correct": false}, {"label": "B", "text": "Unilateral SLN palsy", "correct": true}, {"label": "C", "text": "Unilateral RLN palsy", "correct": false}, {"label": "D", "text": "Bilateral RLN palsy", "correct": false}], "correct_answer": "B. Unilateral SLN palsy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5YJ2vFoL2zHyGHBTJP451742991478.mp3", "video": ""}, {"text": "A 45-year-old female presents with hoarseness , shortness of breath and stridor following thyroid surgery. Laryngoscopy reveals bilateral vocal cord paralysis with both cords fixed in paramedian position. Which of the following is the most appropriate immediate management?", "options": [{"label": "A", "text": "Tracheostomy", "correct": true}, {"label": "B", "text": "Vocal cord lateralization", "correct": false}, {"label": "C", "text": "Arytenoidectomy", "correct": false}, {"label": "D", "text": "Observation and voice therapy", "correct": false}], "correct_answer": "A. Tracheostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JbXrBVTXnncIPRRW8Rnm1738576263.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ References:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yJ4g0XaScHf89FqwHhB71742990912.mp3", "video": ""}, {"text": "A 45-year-old male patient presents with hoarseness of voice following a thyroidectomy. On laryngoscopic examination, his vocal cord is found to be in the paramedian position. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bilateral recurrent laryngeal nerve (RLN) paralysis", "correct": false}, {"label": "B", "text": "Unilateral recurrent laryngeal nerve (RLN) paralysis", "correct": true}, {"label": "C", "text": "Superior laryngeal nerve (SLN) paralysis", "correct": false}, {"label": "D", "text": "Paralysis of both RLN and SLN", "correct": false}], "correct_answer": "B. Unilateral recurrent laryngeal nerve (RLN) paralysis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/keaPwXaNUoX1fLhHIFpo1739260386.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Position of Vocal Cords</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location from Midline</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Healthy State</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diseased State</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Median</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Midline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phonation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>RLN paralysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paramedian</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Strong whisper</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral RLN paralysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermediate (Cadaveric)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>—</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paralysis of both RLN &amp; SLN</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gentle abduction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quiet respiration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Paralysis of adductors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Full abduction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 mm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deep respiration</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>—</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6C78a7sszYcvaNdp8fiA1742989744.mp3", "video": ""}, {"text": "Which of the following muscles is primarily responsible for adducting the vocal folds and closing the rima glottidis during phonation?", "options": [{"label": "A", "text": "Posterior cricoarytenoid muscle", "correct": false}, {"label": "B", "text": "Lateral cricoarytenoid muscle", "correct": true}, {"label": "C", "text": "Thyroepiglotticus", "correct": false}, {"label": "D", "text": "Thyrohyoid muscle", "correct": false}], "correct_answer": "B. Lateral cricoarytenoid muscle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1pFNoDsd4n4KSTKRpnyg1738576082.png", "https://image.prepladder.com/content/GBCeYIWvWLYfsVOxVTBe1738576095.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WdjS4QMITa3QI8ffgNfe1742982715.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 28 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 19 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following statements about the spaces of the larynx is true?", "options": [{"label": "A", "text": "The paraglottic space is located above the infrahyoid epiglottis.", "correct": false}, {"label": "B", "text": "The preepiglottic space is continuous with the paraglottic space.", "correct": true}, {"label": "C", "text": "Reinke's space is located between the quadrangular membrane and the thyroid cartilage.", "correct": false}, {"label": "D", "text": "Tumours in the preepiglottic space typically extend into the neck via the cricothyroid membrane.", "correct": false}], "correct_answer": "B. The preepiglottic space is continuous with the paraglottic space.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Boundaries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Relevance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Preepiglottic Space (Space of Boyer)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior and superior to the <span class=\"customMeta\" data-dictid=\"604985e2361692777190a81eb61544\">infrahyoid</span> epiglottis<strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anterior: Upper <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and <span class=\"customMeta\" data-dictid=\"c28dda8ac016927772002610f0ea78\">thyrohyoid</span> membrane</li>\n<li>Superior: <span class=\"customMeta\" data-dictid=\"54e182d4f016927771898614b7ae64\">Hyoepiglottic</span> ligament</li>\n<li>Posterior: <span class=\"customMeta\" data-dictid=\"10fb32586216927771969cbd47c283\">Quadrangular</span> membrane</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Areolar tissue, fat, lymphatics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be invaded by cancers of the <span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\">supraglottic</span> <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> or base of the tongue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Paraglottic Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral to the laryngeal ventricle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lateral: <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> cartilage</li>\n<li>Medial: <span class=\"customMeta\" data-dictid=\"10fb32586216927771969cbd47c283\">Quadrangular</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and ventricle</li>\n<li>Inferomedial: <span class=\"customMeta\" data-dictid=\"6db2a783271692777185e7165958cd\">Conus</span> elasticus</li>\n<li>Posterior: <span class=\"customMeta\" data-dictid=\"e7527c69f5169277719579acc480d4\">Piriform</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> mucosa</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N/A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumours may extend into the neck via the <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> membrane</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Reinke's Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Beneath the <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> of the vocal cords</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bounded by <span class=\"customMeta\" data-dictid=\"734bdc6ddd1692777182e15cb76ca5\">arcuate</span> lines running from the vocal process of <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> to the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> commissure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Subepithelial <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oedema in this space results in Reinke's oedema, causing vocal cord swelling.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Bqjnf11lypTDykHyuN381742804042.mp3", "video": ""}, {"text": "A 35-year-old teacher presents with hoarseness and vocal fatigue over the past few months. Laryngoscopy reveals bilateral lesions at the junction of the anterior 1/3rds and posterior 2/3rds of the vocal cords. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Vocal Polyp", "correct": false}, {"label": "B", "text": "Vocal Nodule", "correct": true}, {"label": "C", "text": "Laryngeal Papilloma", "correct": false}, {"label": "D", "text": "Reinke's Edema", "correct": false}], "correct_answer": "B. Vocal Nodule", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FZxtnhPHJXESRkRvT0Y71737974757.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vocal <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">Nodule</span> (Singer or screamer's nodule)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vocal Polyp</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic vocal abuse (teachers, actors, vendors or pop singers. )</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden Vocal abuse like shouting (Men in the age group of 30-50 years).</li>\n<li>Heavy smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laterality </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral or symmetrical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location </strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Free edge of vocal cord at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 1/3rd and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> 2/3rd. This</p>\n<p>is the area of maximum <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> of the vocal cord.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Same as vocal nodules.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sessile , Reddish in the early stage and white in the chronic stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth and pedunculated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hoarseness, <span class=\"customMeta\" data-dictid=\"70f48cb1981692777202b78ba53214\">vocal fatigue</span> and neck pain on prolonged phonation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hoarseness of voice and <span class=\"customMeta\" data-dictid=\"28f07d3bee1692777186c271b5856e\">diplophonia</span> (double voice due to different vibrating frequencies of two vocal cords)</li>\n<li>Large polyps- dyspnea, stridor, choking.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Initially, voice rest.</li>\n<li>If it fails -</li>\n<li>microscopic <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> without injuring the vocal ligament</li>\n<li>Speech therapy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Microscopic excision</li>\n<li>Speech therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hIOSipk12ldVJe0tHEOM1742554747.mp3", "video": ""}, {"text": "A 5 y/o boy presents with a history of progressive hoarseness and stridor. Laryngoscopy reveals multiple warty lesions in the larynx. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Juvenile-onset laryngeal papillomatosis", "correct": true}, {"label": "B", "text": "Vocal Polyp", "correct": false}, {"label": "C", "text": "Adult-onset laryngeal papillomatosis", "correct": false}, {"label": "D", "text": "Vocal Nodule", "correct": false}], "correct_answer": "A. Juvenile-onset laryngeal papillomatosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IVQteaBpzFHSpFfGFBI11737973947.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:538px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Juvenile-Onset Laryngeal <span class=\"customMeta\" data-dictid=\"e6a08d4d3e16927771948b8b25fc77\">Papillomatosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Adult-Onset Laryngeal Papillomatosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infants and young children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-50years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sex </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No sex predisposition.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in males.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mode of</strong></p>\n<p style=\"text-align: center;\"><strong>transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mother to child during <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> delivery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sexual intercourse.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Number</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mostly the <span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\">supraglottic</span> and glottic regions. But can also involve the subglottis, <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> and bronchi.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior half of vocal cord or the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> commisure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Presentation </strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hoarseness, aphonia, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> difficulty and stridor.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Change in voice (initial),</p>\n<p>airway obstruction, respiratory</p>\n<p>distress and stridor.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aggressive </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aggressive, <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> is common after excision.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less aggressive does not recur after excision.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Recurrence rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Mn5uJeUavLR2HmsUKu3d1742555507.mp3", "video": ""}, {"text": "A 50 y/o man with a history of chronic cough and weight loss presents with hoarseness and severe throat pain. Laryngoscopy reveals ulcerative lesions predominantly in the posterior part of the larynx, with some areas of hyperemia and swelling. His chest X-ray shows cavitary lesions. Based on the patient's history and laryngeal findings, which condition is most likely responsible for the observed laryngeal lesions?", "options": [{"label": "A", "text": "Laryngeal Papillomatosis", "correct": false}, {"label": "B", "text": "Reinke’s Edema", "correct": false}, {"label": "C", "text": "Lupus of the Larynx", "correct": false}, {"label": "D", "text": "Tuberculosis of the Larynx", "correct": true}], "correct_answer": "D. Tuberculosis of the Larynx", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/9iu4WyUpTewJ07Dmuzwm1737973150.png", "https://image.prepladder.com/content/5ocaw4MNyBdL2TnWbvOl1737973176.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3 style=\"text-align:center\"><strong>Tuberculosis of the Larynx</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lupus of larynx</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Secondary to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> tuberculosis.</li>\n<li>Affects middle-aged males.</li>\n<li>Spread occurs via <span class=\"customMeta\" data-dictid=\"7cabf0723c1692777183971e234185\">bronchogenic</span> or haematogenous routes.</li>\n<li>Tubercle <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> from <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> settle in laryngeal mucosa, leading to infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Indolent <span class=\"customMeta\" data-dictid=\"daf5ee63361692777201129f498a4d\">tubercular</span> infection associated with <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> of the nose and pharynx.</li>\n<li>Lupus primarily affects the <strong>anterior part</strong> of the larynx.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Affects the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> more than the anterior.</li>\n<li>Common sites: <span class=\"customMeta\" data-dictid=\"470e25e266169277719072777c37e7\">interarytenoid</span> fold, <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> bands, vocal cords, and epiglottis.</li>\n<li>Formation of <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> tubercles, which may <span class=\"customMeta\" data-dictid=\"8ff7e19ae9169277720147c54e6777\">ulcerate</span> and cause <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> (pseudoedema).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Starts in the <strong>epiglottis</strong>, which may be destroyed.</li>\n<li>Lesion spreads to the <strong>aryepiglottic folds</strong> and <strong>ventricular bands</strong>.</li>\n<li>No association with <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> tuberculosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong>:</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weakness of voice (early symptom)</li>\n<li>Hoarseness</li>\n<li>Severe pain, radiating to ears, especially with ulceration</li>\n<li>Dysphagia in later stages.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Iveta Paulauskienė,Vaiva Mickevičienė\" data-hash=\"\" data-license=\"CC BY-NC ND 3.0\" data-source=\"https://www.researchgate.net/figure/Videostroboscopy-before-the-surgery-granuloma-on-2nd-and-3rd-thirds-of-the-right-vocal_fig1_303146765\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/9iu4WyUpTewJ07Dmuzwm1737973150.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless condition.</li>\n<li>Often asymptomatic, found incidentally during <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> evaluation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signs</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hyperaemia</strong> of vocal cords (impaired adduction)</li>\n<li>Swelling in <span class=\"customMeta\" data-dictid=\"8571221d1416927771909046a403e4\">inter</span> <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> region with a <strong>mamillated appearance</strong></li>\n<li>Ulceration of vocal cords (\"<strong>mouse-nibbled\" appearance</strong>)</li>\n<li>Superficial ragged ulcerations on arytenoids and <span class=\"customMeta\" data-dictid=\"8571221d1416927771909046a403e4\">inter</span> <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> region</li>\n<li>Granulation tissue in <span class=\"customMeta\" data-dictid=\"8571221d1416927771909046a403e4\">inter</span> <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> region</li>\n<li>Pseudoedema of the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> (\"<strong>turban epiglottis\"</strong>)</li>\n<li>Swelling of <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> bands and <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> folds</li>\n<li>The <span class=\"customMeta\" data-dictid=\"dd5d862f051692777194647422e1c9\">pallor</span> of the surrounding mucosa</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"240\" src=\"https://image.prepladder.com/content/5ocaw4MNyBdL2TnWbvOl1737973176.png\" width=\"569\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Destruction of the epiglottis.</li>\n<li>Involvement of <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> folds and <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> bands.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray of chest</li>\n<li>Sputum examination for tuberculosis</li>\n<li>Biopsy of laryngeal <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> to exclude carcinoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Routine laryngeal examination in patients with <strong>lupus of the nose</strong>.</li>\n<li>No <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB involvement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Treat the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> (antitubercular drugs).</li>\n<li>Voice rest</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Antitubercular drugs</strong>.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> is generally good.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JXmYn85p67aAfPQSzCcC1742559207.mp3", "video": ""}, {"text": "A 45 y/o woman with a history of heavy smoking presents with a low-pitched, rough voice and noticeable hoarseness. Laryngoscopy reveals the following findings. What is the most likely diagnosis for this patient's condition?", "options": [{"label": "A", "text": "Vocal Polyp", "correct": false}, {"label": "B", "text": "Reinke’s Edema", "correct": true}, {"label": "C", "text": "Laryngeal Papillomatosis", "correct": false}, {"label": "D", "text": "Vocal Nodule", "correct": false}], "correct_answer": "B. Reinke’s Edema", "question_images": ["https://image.prepladder.com/content/x36fTY5pJIttLXHt30Uv1737973043.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bunPsKXC86gnVAEXIYTc1746641033.mp3", "video": ""}, {"text": "A 50 y/o man with a history of tobacco chewing presents with a white patch on his laryngeal mucosa which is not easy to scrape off. Oral examination reveals a smooth white patch with no red or ulcerative areas. The patient reports no significant pain or symptoms. What is the most likely diagnosis for this patient's oral lesion?", "options": [{"label": "A", "text": "Oral Candidiasis", "correct": false}, {"label": "B", "text": "Leukoplakia", "correct": true}, {"label": "C", "text": "Lichen Planus", "correct": false}, {"label": "D", "text": "Oral submucous Fibrosis", "correct": false}], "correct_answer": "B. Leukoplakia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TJHyfWFXxWyMEQi5Fu9V1737972734.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:556px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>White patch on oral mucosa, defined clinically, excluding conditions like <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> planus, candidiasis, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Smoking, tobacco chewing</strong></li>\n<li>Alcohol abuse (especially with smoking)</li>\n<li>Chronic trauma (ill-fitting dentures, cheek bites)</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"b49bba8e8a16927771997b281fd66a\">submucous</span> fibrosis, hyperplastic candidiasis, Plummer-Vinson syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Buccal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (most common in India)</li>\n<li>Oral commissures, floor of mouth, tongue, gingivobuccal sulcus, lip mucosa</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age &amp; Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Men in their 40s are 2-3 times more affected than females.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Homogenous</strong>: Smooth or wrinkled white patch, lower <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n<li><strong>Nodular (speckled)</strong>: White patches on an erythematous base, higher <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n<li><strong>Erosive (erythroleukoplakia)</strong>: Interspersed with red patches, fissures, highest <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignant potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>1-17.5% risk, average 5% <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation</li>\n<li>Higher risk in <span class=\"customMeta\" data-dictid=\"fd29b16a0e1692777186324bd9a553\">dysplastic</span> lesions and certain locations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Remove <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> factors</strong>: <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">Spontaneous</span> <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> in some cases.</li>\n<li><strong>Biopsy</strong>: For lesions with high <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential.</li>\n<li><strong>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or laser/cryotherapy</strong>: For suspicious or small lesions</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qlqQTcUkwnChokKIbODz1742560309.mp3", "video": ""}, {"text": "A 55 y/o man, who is a heavy smoker and drinker, visits complaining of a persistent husky voice and throat irritation. During a laryngoscopic examination, the following is observed. Based on the above image, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Pachyderma Laryngitis", "correct": true}, {"label": "B", "text": "Vocal Polyp", "correct": false}, {"label": "C", "text": "Acute Laryngitis", "correct": false}, {"label": "D", "text": "Vocal Cord Nodules", "correct": false}], "correct_answer": "A. Pachyderma Laryngitis", "question_images": ["https://image.prepladder.com/notes/LUm2PS1tf4cBzeY0I7Ff1742626332.png"], "explanation_images": ["https://image.prepladder.com/notes/BA0Q5PY95EyizetLEy551742626424.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hoarseness or husky voice.</li>\n<li>Throat irritation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Laryngoscopic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Red or grey <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue in the <span class=\"customMeta\" data-dictid=\"470e25e266169277719072777c37e7\">interarytenoid</span> region.</li>\n<li>Ulcerations on the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> thirds of the vocal cords (contact ulcers).</li>\n<li>Bilateral and <span class=\"customMeta\" data-dictid=\"d963da62eb16927771993737a99c7c\">symmetrical</span> changes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Malignant Potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Typically does not progress to malignancy.</li>\n<li>Biopsy is essential to rule out <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> or tuberculosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The exact cause is uncertain.</li>\n<li>Predominantly in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> who smoke and consume excessive alcohol.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Contributing Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Excessive and forceful talking.</li>\n<li>Gastroesophageal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease (GERD), leads to <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> from <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> stomach fluids.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Removal of <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">Granulation</span> Tissue:</u> Performed microsurgically, may require multiple sessions.</li>\n<li><u>Acid <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">Reflux</span> Management:</u> Includes lifestyle changes, medications, or surgery.</li>\n<li><u>Speech Therapy:</u> Focuses on proper voice techniques and reducing vocal strain.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MY20uDVyvKdJoWQsY1jT1742561055.mp3", "video": ""}, {"text": "A 3 y/o child presents with a 2-day history of a worsening cough, fever, and difficulty breathing. The parents report that the child's cough has a characteristic \"barking\" quality, and they have noticed increased difficulty in breathing, especially at night. The child appears irritable and distressed. O/E there are signs of respiratory distress. An anteroposterior X-ray of the neck is done. Based on the clinical presentation and X-ray findings, which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute Epiglottitis", "correct": false}, {"label": "B", "text": "Croup (Acute Laryngotracheobronchitis)", "correct": true}, {"label": "C", "text": "Foreign Body Aspiration", "correct": false}, {"label": "D", "text": "Tracheitis (Subglottic Stenosis)", "correct": false}], "correct_answer": "B. Croup (Acute Laryngotracheobronchitis)", "question_images": ["https://image.prepladder.com/content/Nru2YvoK5zOU9pzDG2Ey1739265737.png"], "explanation_images": ["https://image.prepladder.com/content/bZ1Q4ybXJqwSHONwzG7X1738685182.png", "https://image.prepladder.com/content/fWDyVbhwLbI7jqvmB1AC1738685190.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute Epiglottitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Croup (Acute Laryngotracheobronchitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Visualisation:</u> Red and swollen <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> (avoid <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">laryngoscopy</span> to prevent <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction).</li>\n<li><u>Lateral Neck X-ray:</u> \"Thumb sign\" indicating swollen epiglottis.</li>\n<li><strong>(Option A ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Differentiated based on clinical features (e.g., absence of drooling, voice quality).</li>\n<li>The \"steeple sign\" on an <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> view shows a narrowing of the upper airway, often seen in croup.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>X-Ray Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Niknejad M, Sharma R, Bell D\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/thumb-sign-epiglottitis-1?lang=gb\" data-tags=\"\" height=\"3201\" src=\"https://image.prepladder.com/content/bZ1Q4ybXJqwSHONwzG7X1738685182.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Frank Gaillard,\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Croup_steeple_sign.jpg\" data-tags=\"\" height=\"3088\" src=\"https://image.prepladder.com/content/fWDyVbhwLbI7jqvmB1AC1738685190.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hospitalisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Required due to the high risk of <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often necessary due to potential breathing difficulties.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Antibiotics:</u> <span class=\"customMeta\" data-dictid=\"f4eacdbe7b1692777194d7caa2017d\">Parenteral</span> administration (e.g., ampicillin, third-generation cephalosporins).</li>\n<li><u>Steroids:</u> <span class=\"customMeta\" data-dictid=\"3ad7a8484f16927771892d460daa4b\">Hydrocortisone</span> or <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> to reduce oedema.</li>\n<li><u>Hydration:</u> IV fluids if needed.</li>\n<li><u>Humidified Oxygen:</u> Via mist tent or croupette.</li>\n<li><u>Intubation or Tracheostomy:</u> In cases of severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> obstruction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Antibiotics:</u> <span class=\"customMeta\" data-dictid=\"e1a1f4fa35169277718150f74fa895\">Ampicillin</span> 50 mg/kg/day against the H. <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> virus.</li>\n<li><u>Humidification:</u> Helps clear crusts and thick secretions that block the <span class=\"customMeta\" data-dictid=\"869f194fb11692777200fc402d40af\">tracheobronchial</span> tree.</li>\n<li><u>Steroids</u>: to reduce oedema.</li>\n<li><u>Racemic Epinephrine:</u> Used as a bronchodilator.</li>\n<li><u>Intubation or Tracheostomy:</u> Considered if <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> worsens or lasts beyond 72 hours.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dNFHqdYwR8u9IMEqTJzP1742561549.mp3", "video": ""}, {"text": "Which of the following is true regarding acute epiglottitis compared to croup?", "options": [{"label": "A", "text": "Acute epiglottitis is more commonly caused by viral infections.", "correct": false}, {"label": "B", "text": "Croup typically has an abrupt onset and rapid progression.", "correct": false}, {"label": "C", "text": "The \"thumb sign\" on a lateral neck X-ray is a characteristic of croup.", "correct": false}, {"label": "D", "text": "Acute epiglottitis in children can lead to life-threatening airway obstruction.", "correct": true}], "correct_answer": "D. Acute epiglottitis in children can lead to life-threatening airway obstruction.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4XTdVTiTYJUwMNeB23yi1737971254.png", "https://image.prepladder.com/content/5Hl00BDL2KvgwqUzAuQb1737971304.png", "https://image.prepladder.com/content/mflxBVXNqqnsrZXapGjY1737971413.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute Epiglottitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Croup (Acute Laryngotracheobronchitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Haemophilus influenzae <span class=\"customMeta\" data-dictid=\"0dddac147b1692777201460ab59600\">type B</span> (most common in children)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Viral infections (Parainfluenza types I and II most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abrupt onset, rapid progression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Starts as an upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infection with <span class=\"customMeta\" data-dictid=\"4da1fe73a71692777189ec55b7ed8c\">hoarseness</span> and a \"croupy\" <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> then progress down to <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> l/t barking cough</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects children 2–7 years old; can also occur in adults</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common, affects children 6 months–3 years old (more common in males)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sore throat, <span class=\"customMeta\" data-dictid=\"2749f813cb16927771864616f3317f\">dysphagia</span> , salivary drooling and <span class=\"customMeta\" data-dictid=\"83962896b5169277720032c8e8bd50\">tripod</span> <span class=\"customMeta\" data-dictid=\"115643fed616927771961316effc71\">posture</span> (Adults)</p>\n<p>Dyspnoea, stridor, rapid <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (respiratory emergency in Children)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild and slow <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> as compared to <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> epiglottitis. Hoarseness, <span class=\"customMeta\" data-dictid=\"178653b4ec1692777185f77f5b74d0\">croupy</span> cough, difficulty breathing, inspiratory stridor, <span class=\"customMeta\" data-dictid=\"751ea5589f1692777199db9f2ec233\">suprasternal</span> and <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> retractions (severe cases).</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High fever (up to 40°C), often with septicaemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mild to moderate fever</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visualisation of red, swollen epiglottis</li>\n<li>\"Thumb sign\" on <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> of the neck.</li>\n<li>Avoid <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> laryngoscopy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Differentiated from <span class=\"customMeta\" data-dictid=\"116f86834a1692777187cc42a05978\">epiglottitis</span> by clinical features, no \"thumb sign\"</li>\n<li>A steeple sign is seen on the X-ray.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>X-Ray Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Niknejad M, Sharma R, Bell D\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/thumb-sign-epiglottitis-1?lang=gb\" data-tags=\"\" height=\"3201\" src=\"https://image.prepladder.com/content/4XTdVTiTYJUwMNeB23yi1737971254.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Frank Gaillard,\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Croup_steeple_sign.jpg\" data-tags=\"\" height=\"3088\" src=\"https://image.prepladder.com/content/5Hl00BDL2KvgwqUzAuQb1737971304.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/87ZrvdANx4Jo1Ez2EpV11742805017.mp3", "video": ""}, {"text": "Which of the following features is a characteristic of the infant larynx compared to the adult larynx?", "options": [{"label": "A", "text": "The larynx is positioned opposite the C5 vertebra at rest.", "correct": false}, {"label": "B", "text": "The thyroid cartilage has a well-defined angle.", "correct": false}, {"label": "C", "text": "The subglottis is the narrowest part of the larynx.", "correct": true}, {"label": "D", "text": "The arytenoid cartilages are smaller and cover less of the posterior glottis", "correct": false}], "correct_answer": "C. The subglottis is the narrowest part of the larynx.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Infant Larynx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adult Larynx</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher in the neck; <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> at C3-C4 at rest, C1-C2 during <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> (allows simultaneous breathing &amp; swallowing)</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower in the neck; vocal cords at the level of C5 vertebra</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Cartilage Consistency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Softer and more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to collapse</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Firmer, less <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to collapse</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Epiglottis Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Omega (Ω)-shaped</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leaf-shaped</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Arytenoid Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proportionally larger, covers more of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smaller compared to infant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Thyroid Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flat, overlaps <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone (narrows <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> and <span class=\"customMeta\" data-dictid=\"c28dda8ac016927772002610f0ea78\">thyrohyoid</span> spaces) <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A more defined angle does not <span class=\"customMeta\" data-dictid=\"ea564f2f5e1692777194df1391fd69\">overlap</span> <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Larynx Shape and Size</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smaller, conical; <span class=\"customMeta\" data-dictid=\"d3c3b6066416927771998a86f25bc5\">subglottis</span> is the narrowest part</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larger, cylindrical; <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> and <span class=\"customMeta\" data-dictid=\"d3c3b6066416927771998a86f25bc5\">subglottis</span> are similar in size</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Submucosal Tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Looser, more <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to oedema, risk of obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Denser, less <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> to oedema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Growth Spurts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two growth spurts: 1st during the first 3 years (width and length), 2nd in <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> (vocal cord growth, voice changes)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Larynx growth complete after adolescence</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/xdqoiXcgi8EdK2BM4cS11742804456.mp3", "video": ""}, {"text": "Which of the following is a paired hyaline cartilage of the larynx?", "options": [{"label": "A", "text": "Cuneiform", "correct": false}, {"label": "B", "text": "Arytenoid", "correct": true}, {"label": "C", "text": "Corniculate", "correct": false}, {"label": "D", "text": "Thyroid", "correct": false}], "correct_answer": "B. Arytenoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FGNI9aXtyeVQ2juDRFxb1737970426.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Type of Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Paired Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Unpaired Cartilage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Hyaline Cartilage</strong></p>\n<p>(Calcifies with age)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Arytenoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Thyroid <strong>(Option D ruled out)</strong>, Cricoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Elastic Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Corniculate, <span class=\"customMeta\" data-dictid=\"5cd19952761692777185af9b7666f0\">Cuneiform</span> <strong>(Option A &amp; C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Epiglottis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nV4WMGUoxeWzgmWU9LQS1742550130.mp3", "video": ""}, {"text": "Which of the following extrinsic muscles is not an elevator of the larynx?", "options": [{"label": "A", "text": "Sternohyoid", "correct": true}, {"label": "B", "text": "Stylopharyngeus", "correct": false}, {"label": "C", "text": "Mylohyoid", "correct": false}, {"label": "D", "text": "Digastric", "correct": false}], "correct_answer": "A. Sternohyoid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>EXTRINSIC MUSCLES OF THE LARYNX</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Connect the laryngeal cartilages to the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone above and the <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> below.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ELEVATORS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>DEPRESSORS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary elevators </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Act directly as they are attached to the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cartilage.\n\t\t\t\t<ul>\n<li>Stylopharyngeus</li>\n<li>Salpingopharyngeus</li>\n<li>Palatopharyngeus</li>\n<li>Thyrohyoid</li>\n</ul>\n</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sternohyoid</li>\n<li>Sternothyroid</li>\n<li>Omohyoid</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary elevators </strong><strong>(Options C &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Act indirectly as they are attached to the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone.\n\t\t\t\t<ul>\n<li>Mylohyoid (main)</li>\n<li>Digastric</li>\n<li>Stylohyoid</li>\n<li>Geniohyoid</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OSSoVFEN6ovMoJkO612g1742803698.mp3", "video": ""}, {"text": "Which of the following intrinsic muscles of the larynx is a tensor and is derived from the 6th branchial arch?", "options": [{"label": "A", "text": "Vocalis", "correct": false}, {"label": "B", "text": "Cricothyroid", "correct": true}, {"label": "C", "text": "Posterior cricoarytenoid", "correct": false}, {"label": "D", "text": "Transverse Interarytenoid", "correct": false}], "correct_answer": "B. Cricothyroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uA1CqUEszILrlLn6oHxY1737970997.png", "https://image.prepladder.com/content/fLG1Mqf9i6UIXqfUaumg1737971007.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Branchial arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laryngeal Structure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4th arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thyroid cartilage</li>\n<li>All muscles except <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> <strong>(Option A, C &amp; D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6th arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Arytenoids, corniculate, <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> and <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> cartilages</li>\n<li>Cricothyroid muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypobranchial eminence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epiglottis</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>INTRINSIC MUSCLES OF THE LARYNX</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acting on the vocal cord</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acting on the Laryngeal inlet</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abductors</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Posterior cricoarytenoid(Safest muscle of larynx)</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Openers of the laryngeal inlet</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thyroepiglottic</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adductors</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lateral cricoarytenoid</li>\n<li>Interarytenoid (unpaired muscle , dual nerve supply by right and left RLN)(transverse arytenoid)</li>\n<li>Thyroarytenoid (external part)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Closers of laryngeal inlet</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Interarytenoid (oblique part)</li>\n<li>Aryepiglottic (posterior <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> part of <span class=\"customMeta\" data-dictid=\"8571221d1416927771909046a403e4\">inter</span> arytenoids)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tensors</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cricothyroid</li>\n<li>Vocalis (internal part of thyroarytenoid)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XFhUfrauqe2fvWy4b7Er1742803487.mp3", "video": ""}, {"text": "What type of epithelium lines the vocal cords, and what is the space between them called?", "options": [{"label": "A", "text": "Non-keratinizing stratified squamous epithelium; Rima vestibularis", "correct": false}, {"label": "B", "text": "Pseudostratified ciliated columnar epithelium; Rima glottidis", "correct": false}, {"label": "C", "text": "Non-keratinizing stratified squamous epithelium; Rima glottidis", "correct": true}, {"label": "D", "text": "Pseudostratified ciliated columnar epithelium; Rima vestibularis", "correct": false}], "correct_answer": "C. Non-keratinizing stratified squamous epithelium; Rima glottidis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sULLh3P6EAefNX6P0H5H1737970895.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Vp6tk7xumJxtYjJNF3D71742802498.mp3", "video": ""}, {"text": "Match the following: 1. Extrinsic Membranes of Larynx a) Quadrangular membrane 2. Intrinsic Membranes of the larynx b) Aryepiglottic membrane c) Thyrohyoid membrane d) Cricothyroid membrane e) Cricovocal membrane", "options": [{"label": "A", "text": "1- a, d, e; 2- b, c", "correct": false}, {"label": "B", "text": "1- c, d; 2- a, b, e", "correct": true}, {"label": "C", "text": "1- a, b; 2- c, d, e", "correct": false}, {"label": "D", "text": "1- b, d, e; 2- a, c", "correct": false}], "correct_answer": "B. 1- c, d; 2- a, b, e", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OUEsL0JCT83x2Nw87wGA1737970813.png", "https://image.prepladder.com/content/cCEoyRcnfqmekSLEByAl1737970825.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extrinsic Membranes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intrinsic Membranes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Connecting laryngeal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> to extra laryngeal structure.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Connecting laryngeal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> to another laryngeal cartilage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thyrohyoid membrane</strong>- Pierced by superior laryngeal vessels and internal laryngeal nerve.</li>\n<li><strong>Cricothyroid membrane</strong>- Pierced in a <span class=\"customMeta\" data-dictid=\"d2448812171692777185adac472e7e\">cricothyroidotomy</span> during access for an emergency airway</li>\n<li><strong>Hyoepiglottic ligament</strong>- Connects <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> to the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Aryepiglottic membrane</strong>- Completely seals off the laryngeal spaces, creating a <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> that protects the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> and lungs from foreign bodies.</li>\n<li><strong>Quadrangular membrane</strong>- The lower border forms the <span class=\"customMeta\" data-dictid=\"e8b3c606051692777201faf2a1a357\">vestibular</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> which forms the false cord.</li>\n<li><strong>Cricovocal/ <span class=\"customMeta\" data-dictid=\"6db2a783271692777185e7165958cd\">Conus</span> elasticus membrane</strong>- Connects the thyroid, cricoid, and <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> cartilages, forming the vocal <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> and <span class=\"customMeta\" data-dictid=\"6db2a783271692777185e7165958cd\">conus</span> elasticus. It provides a site where <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> foreign bodies may become impacted.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1793\" src=\"https://image.prepladder.com/content/OUEsL0JCT83x2Nw87wGA1737970813.png\" width=\"1886\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1131\" src=\"https://image.prepladder.com/content/cCEoyRcnfqmekSLEByAl1737970825.png\" width=\"2632\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Qh9jhKhbibjSdH2InugE1742802087.mp3", "video": ""}, {"text": "Which of the following statements is false regarding the arytenoid, corniculate, and cuneiform cartilages?", "options": [{"label": "A", "text": "The arytenoid cartilages have a base that articulates with the cricoid cartilage.", "correct": false}, {"label": "B", "text": "The corniculate cartilages articulate with the apex of the arytenoid cartilages.", "correct": false}, {"label": "C", "text": "The cuneiform cartilages provide support to the vocal cords.", "correct": true}, {"label": "D", "text": "The corniculate cartilages are responsible for supporting the aryepiglottic fold.", "correct": false}], "correct_answer": "C. The cuneiform cartilages provide support to the vocal cords.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8OH8l99D8M0kZ4yFRwJZ1739259420.png", "https://image.prepladder.com/content/8IoMnt6BSemxIs7Hmdg71737970739.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CARTILAGE</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>DESCRIPTION</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>ARYTENOID</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Paired <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">Hyaline</span> Cartilage.</li>\n<li>Each <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> is shaped like a pyramid.</li>\n<li><strong>Base</strong>: The base of each <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> articulates with the <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilage. <strong>(Option A ruled out)</strong></li>\n<li><strong>Muscular Process</strong>: A <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> projection where <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> laryngeal muscles attach.</li>\n<li><strong>Vocal Process</strong>: <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> projection that provides <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> for the vocal cords.</li>\n<li><strong>Apex</strong>: The top part of the <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> that supports the <span class=\"customMeta\" data-dictid=\"feec708d7f16927771857d15026de2\">corniculate</span> cartilage.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2175\" src=\"https://image.prepladder.com/content/8OH8l99D8M0kZ4yFRwJZ1739259420.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CORNICULATE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cartilages of Santorini</li>\n<li>There are two <span class=\"customMeta\" data-dictid=\"feec708d7f16927771857d15026de2\">corniculate</span> cartilages, one on each side.</li>\n<li>Elastic cartilage</li>\n<li>Each <span class=\"customMeta\" data-dictid=\"feec708d7f16927771857d15026de2\">corniculate</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> articulates with the <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> of the <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> cartilage. <strong>(Option B ruled out)</strong></li>\n<li>They resemble horns (hence the name \"corniculate\") and function to support the <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> fold. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1536\" src=\"https://image.prepladder.com/content/8IoMnt6BSemxIs7Hmdg71737970739.png\" width=\"1492\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CUNEIFORM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cartilages of Wrisberg</li>\n<li>Paired <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> Cartilage.</li>\n<li>Each <span class=\"customMeta\" data-dictid=\"5cd19952761692777185af9b7666f0\">cuneiform</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> has a rod-like shape.</li>\n<li>Positioned in the <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> fold in front of the <span class=\"customMeta\" data-dictid=\"feec708d7f16927771857d15026de2\">corniculate</span> cartilage.</li>\n<li>Provides <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> support to the <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> fold, enhancing its stability.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/x5pLw84kzHao1CouWxN51742801694.mp3", "video": ""}, {"text": "Which of the following is true about the epiglottis?", "options": [{"label": "A", "text": "It is an unpaired hyaline cartilage.", "correct": false}, {"label": "B", "text": "Preepiglottic space is not associated with cancers involving the base of the tongue.", "correct": false}, {"label": "C", "text": "It is connected to the hyoid bone by the hyoepiglottic ligament.", "correct": true}, {"label": "D", "text": "It is NON essential for swallowing and cannot be safely removed.", "correct": false}], "correct_answer": "C. It is connected to the hyoid bone by the hyoepiglottic ligament.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HS7kiLKsmCwv2XiseXEP1737970578.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9tDugPEBrOIJjIXqkuYl1742800499.mp3", "video": ""}, {"text": "A 60-year-old male presents with hoarseness of voice and breathing difficulties following minor neck trauma. During evaluation, imaging reveals calcified structures in the laryngeal region. What is the most likely cause for this finding?", "options": [{"label": "A", "text": "Displacement of the thyroid cartilage from its normal position", "correct": false}, {"label": "B", "text": "Formation of fibrous tissue in the cricoid cartilage", "correct": false}, {"label": "C", "text": "Inflammatory changes in the arytenoid cartilage", "correct": false}, {"label": "D", "text": "Age-related ossification of cricoid cartilage", "correct": true}], "correct_answer": "D. Age-related ossification of cricoid cartilage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wLXYJrJDMB48JD172fEu1737970535.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4b8rK3DJsNwwxQpaRzuF1742550937.mp3", "video": ""}, {"text": "Which of the following statements about the thyroid cartilage is correct?", "options": [{"label": "A", "text": "Smallest cartilage in the larynx.", "correct": false}, {"label": "B", "text": "The alae of the thyroid cartilage meet at an angle of 120° in males.", "correct": false}, {"label": "C", "text": "It is an unpaired hyaline cartilage.", "correct": true}, {"label": "D", "text": "Foreign bodies are typically arrested below the vocal cords", "correct": false}], "correct_answer": "C. It is an unpaired hyaline cartilage.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ODjQSnREUpQjHFpz4bs91737970475.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/J3BNdPjY08aZO1UMrVwM1742550387.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 29 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 52 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Except in which of the following is laryngeal crepitus not present?", "options": [{"label": "A", "text": "Post-cricoid malignancy", "correct": false}, {"label": "B", "text": "Hypopharyngeal abscess", "correct": false}, {"label": "C", "text": "Parapharyngeal abscess", "correct": false}, {"label": "D", "text": "Prevertebral abscess", "correct": true}], "correct_answer": "D. Prevertebral abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ouMbtw3N0clv6z7c2hq31746703048.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laryngeal <span class=\"customMeta\" data-dictid=\"2483707fe9169277718541a169f5b4\">Crepitus</span> Presence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Reason</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-cricoid malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Present</strong> (unless advanced)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumors in this area usually do not fix the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> early</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypopharyngeal abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Present or reduced</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May affect laryngeal movement but not always abolish crepitus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parapharyngeal abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Present or reduced</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can restrict <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> movement but does not fix <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> completely</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prevertebral abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixes the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> to the spine, preventing movement</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What nerve is most likely to be damaged when the cough reflex is impaired due to alcohol ingestion and other conditions, resulting in the prevention of foreign body entry into the laryngeal inlet?", "options": [{"label": "A", "text": "Internal laryngeal nerve", "correct": true}, {"label": "B", "text": "Glossopharyngeal nerve", "correct": false}, {"label": "C", "text": "External laryngeal nerve", "correct": false}, {"label": "D", "text": "Recurrent laryngeal nerve", "correct": false}], "correct_answer": "A. Internal laryngeal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/HiBf7coSyImKGWT7nTWE1745324495.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "CT scan of a patient with laryngeal carcinoma is shown below. What is the staging?", "options": [{"label": "A", "text": "Τ1ΝΟΜΟ", "correct": false}, {"label": "B", "text": "T4N1MO", "correct": true}, {"label": "C", "text": "T2N1MO", "correct": false}, {"label": "D", "text": "T3NOMO", "correct": false}], "correct_answer": "B. T4N1MO", "question_images": ["https://image.prepladder.com/notes/VZoSVadlaecJpLb6J07F1746708267.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor is limited to the subglottis. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor extends to the vocal cord(s) with normal or impaired mobility. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor limited to <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord fixation. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> or <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> or esophagus). <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, 3 cm or less in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, more than 3 cm but not more than 6 cm in greatest dimension, or multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension, or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in the greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> more than 3 cm but not more than 6 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N2c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Na</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> more than 6 cm in the greatest dimension</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No Distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How should a patient with diphtheria and right vocal fold palsy be treated?", "options": [{"label": "A", "text": "Wait and watch", "correct": false}, {"label": "B", "text": "Gelfoam injection", "correct": false}, {"label": "C", "text": "Thyroplasty type 1", "correct": true}, {"label": "D", "text": "Fat injection", "correct": false}], "correct_answer": "C. Thyroplasty type 1", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent laryngeal cartilages is least prone to calcification?", "options": [{"label": "A", "text": "Thyroid", "correct": false}, {"label": "B", "text": "Cricoid", "correct": false}, {"label": "C", "text": "Arytenoid", "correct": false}, {"label": "D", "text": "Epiglottis", "correct": true}], "correct_answer": "D. Epiglottis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Y7exBiF0bMc31K66GITu1747902112.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Type of Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Paired Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Unpaired Cartilage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hyaline Cartilage</strong></p>\n<p>(Calcifies with age)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Arytenoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Thyroid, Cricoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Elastic Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Corniculate, Cuneiform</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Epiglottis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not employed in post-laryngectomy rehabilitation?", "options": [{"label": "A", "text": "Tracheoesophageal prosthesis", "correct": false}, {"label": "B", "text": "Esophageal speech", "correct": false}, {"label": "C", "text": "Super supraglottic swallow", "correct": true}, {"label": "D", "text": "Polite yawning", "correct": false}], "correct_answer": "C. Super supraglottic swallow", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/yHUkGg4utyZNFuDW8xbd1745402434.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is a drug called Mitomycin-C used for in medical treatment?", "options": [{"label": "A", "text": "Subglottic stenosis", "correct": true}, {"label": "B", "text": "Rhinocerebral mucormycosis", "correct": false}, {"label": "C", "text": "Adenoidectomy", "correct": false}, {"label": "D", "text": "Tympanoplasty", "correct": false}], "correct_answer": "A. Subglottic stenosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\"&gt;Subglottic&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a life-threatening nerve injury?", "options": [{"label": "A", "text": "Bilateral Complete RLN Palsy", "correct": true}, {"label": "B", "text": "Bilateral Partial RLN palsy", "correct": false}, {"label": "C", "text": "Unilateral complete RLN palsy", "correct": false}, {"label": "D", "text": "Unilateral partial RLN palsy", "correct": false}], "correct_answer": "A. Bilateral Complete RLN Palsy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jI02iIlGk1adSP4qV4Wt1741773005.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with laryngeal cancer who has undergone a total laryngectomy, determine the mode of voice production depicted in the provided image.", "options": [{"label": "A", "text": "Tracheoesophageal prosthesis", "correct": false}, {"label": "B", "text": "Chicago implant", "correct": false}, {"label": "C", "text": "Electro larynx", "correct": true}, {"label": "D", "text": "Esophageal speech", "correct": false}], "correct_answer": "C. Electro larynx", "question_images": ["https://image.prepladder.com/notes/HlTVTzEjOU89Xg3gou5p1746599829.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old child presented with the following X-ray finding. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute laryngotracheobronchitis", "correct": true}, {"label": "B", "text": "Acute epiglottitis", "correct": false}, {"label": "C", "text": "Acute pharyngitis", "correct": false}, {"label": "D", "text": "Parapharyngeal abscess", "correct": false}], "correct_answer": "A. Acute laryngotracheobronchitis", "question_images": ["https://image.prepladder.com/notes/QQ1EGLr9zHM71v5RE7tR1746450383.png"], "explanation_images": ["https://image.prepladder.com/notes/RcPKhDgR0TgzCZHlXif71746450507.png", "https://image.prepladder.com/notes/z4nfuexAKzHJ8jqOVI1K1746450455.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; laryngotracheobronchitis:</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute Epiglottitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Croup (Acute Laryngotracheobronchitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visualisation: Red and swollen <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> (avoid <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">laryngoscopy</span> to prevent <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction).</li>\n<li>Lateral Neck X-ray: \"Thumb sign\" indicating swollen epiglottis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Differentiated based on clinical features (e.g., absence of drooling, voice quality).</li>\n<li>The \"steeple sign\" on an X-ray <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> view shows a narrowing of the upper airway, often seen in croup.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>X-Ray Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"EN310\" data-author=\"Niknejad M, Sharma R, Bell D\" data-hash=\"12059\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/thumb-sign-epiglottitis-1?lang=gb\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/RcPKhDgR0TgzCZHlXif71746450507.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"EN424\" data-author=\"Frank Gaillard,\" data-hash=\"12058\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Steeple_sign#/media/File:Croup_steeple_sign.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/z4nfuexAKzHJ8jqOVI1K1746450455.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Hospitalisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Required due to the high risk of <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often necessary due to potential breathing difficulties.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antibiotics: Parenteral administration (e.g., ampicillin, third-generation cephalosporins).</li>\n<li>Steroids: Hydrocortisone or <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> to reduce oedema.</li>\n<li>Hydration: IV fluids if needed.</li>\n<li>Humidified Oxygen: Via mist tent or croupette.</li>\n<li>Intubation or Tracheostomy: In cases of severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> obstruction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antibiotics: <span class=\"customMeta\" data-dictid=\"e1a1f4fa35169277718150f74fa895\">Ampicillin</span> 50 mg/kg/day against the H. <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> virus.</li>\n<li>Humidification: Helps clear crusts and thick secretions that block the <span class=\"customMeta\" data-dictid=\"869f194fb11692777200fc402d40af\">tracheobronchial</span> tree.</li>\n<li>Steroids: to reduce oedema.</li>\n<li>Racemic Epinephrine: Used as a bronchodilator.</li>\n<li>Intubation or Tracheostomy: Considered if <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> worsens or lasts beyond 72 hours. </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely reason for a patient experiencing breathing difficulties and unsuccessful extubation after undergoing a total thyroidectomy?", "options": [{"label": "A", "text": "Superior laryngeal nerve injury", "correct": false}, {"label": "B", "text": "Unilateral recurrent laryngeal nerve injury", "correct": false}, {"label": "C", "text": "Bilateral recurrent laryngeal nerve injury", "correct": true}, {"label": "D", "text": "Hematoma", "correct": false}], "correct_answer": "C. Bilateral recurrent laryngeal nerve injury", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\"&gt;Bilateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\"&gt;recurrent&lt;/span&gt; laryngeal nerve inju\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organisms does not cause croup?", "options": [{"label": "A", "text": "Parainfluenza 1", "correct": false}, {"label": "B", "text": "Parainfluenza 2", "correct": false}, {"label": "C", "text": "Rhinovirus", "correct": true}, {"label": "D", "text": "RSV", "correct": false}], "correct_answer": "C. Rhinovirus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parainfluenza virus (Types 1, 2, 3) - most common</strong>, RSV, Influenza, Adenovirus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>6 months - 3 years</strong> (most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Barking cough</strong></p>\n<p>2. <strong>Inspiratory stridor</strong></p>\n<p>3. <strong>Hoarseness</strong></p>\n<p>4. <strong>Respiratory distress</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Steeple Sign on X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subglottic narrowing</strong> on <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> neck X-ray</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild:</strong> Supportive care, humidified air</p>\n<p><strong>Moderate-Severe:</strong> <strong>Dexamethasone + Nebulized Epinephrine</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 year old male presented with history of dysphagia, halitosis and aspiration pneumonia. A barium swallow was done and is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Diffuse oesophageal spasm", "correct": false}, {"label": "B", "text": "Achalasia cardia", "correct": false}, {"label": "C", "text": "Zenker’s diverticulum", "correct": true}, {"label": "D", "text": "Esophageal cancer", "correct": false}], "correct_answer": "C. Zenker’s diverticulum", "question_images": ["https://image.prepladder.com/content/be9q14U3GtKEXYiCfHFZ1746705402.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <strong>false diverticulum</strong> formed due to <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> of pharyngeal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> through <strong>Killian’s dehiscence</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cricopharyngeal muscle dysfunction</strong> leading to increased pressure and <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> formation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <strong>Dysphagia</strong> (difficulty swallowing)</p>\n<p>2. <strong>Regurgitation of undigested food</strong></p>\n<p>3. <strong>Halitosis</strong> (bad breath)</p>\n<p>4. <strong>Aspiration pneumonia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Barium swallow X-ray</strong> (shows a <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal pouch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic diverticulotomy (Dohlman’s procedure)</strong> or <strong>open diverticulectomy</strong> in large cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the TNM staging for a patient with carcinoma in the pyriform fossa, presenting with a 5 cm lesion on laryngoscopy, non-mobile right vocal folds, no lymph node involvement, and no distant metastasis?", "options": [{"label": "A", "text": "T2N0M0", "correct": false}, {"label": "B", "text": "T3N0M0", "correct": true}, {"label": "C", "text": "T4aN0M0", "correct": false}, {"label": "D", "text": "T4bN0M0", "correct": false}], "correct_answer": "B. T3N0M0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tumor Size/Extent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vocal Cord Mobility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Metastasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor confined to one subsite of hypopharynx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No nodes (N0)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No (M0)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor extends to more than one subsite or adjacent areas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor <strong>&gt;4 cm</strong> or <strong>vocal cord fixation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades adjacent structures (e.g., thyroid/cricoid cartilage, hyoid, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> gland, esophagus)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0/N+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> fascia, encases <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, or involves <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fixed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0/N+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought to you with complaints of noisy breathing. On examination, you notice the inspiratory stridor in the child, and the laryngeal examination is as below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Vocal cord paralysis", "correct": false}, {"label": "B", "text": "Subglottic stenosis", "correct": false}, {"label": "C", "text": "Laryngeal papilloma", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": true}], "correct_answer": "D. Laryngomalacia", "question_images": ["https://image.prepladder.com/content/Gsj6SzxSkV2vf7Im59JF1746705982.png"], "explanation_images": ["https://image.prepladder.com/content/BgvchF6RF0q9HnlvaHx81746706072.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital <strong>floppy laryngeal cartilage</strong>, especially affecting the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> and arytenoids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inspiratory stridor</strong> (worse when supine, feeding, or crying)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>At birth or within the first few weeks of life</strong>, peaks at <strong>4–8 months</strong>, resolves by <strong>12–24 months</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flexible laryngoscopy</strong> → shows <strong>omega-shaped epiglottis</strong>, redundant <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> mucosa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Observation</strong> in mild cases, <strong>surgical intervention (supraglottoplasty)</strong> in severe cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with hoarseness of voice. On examination an ulceroproliferative mass is seen on the right vocal cord; the cord was however mobile. There is no lymph node involvement and no metastasis. Which of the following is the best treatment modality for this patient?", "options": [{"label": "A", "text": "Total laryngectomy", "correct": false}, {"label": "B", "text": "Radiotherapy", "correct": true}, {"label": "C", "text": "Conservative laryngectomy", "correct": false}, {"label": "D", "text": "Chemotherapy", "correct": false}], "correct_answer": "B. Radiotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male who is a professional trumpet blower presented with a swelling on the left side of the neck. On examination, there is a gurgling sound when compressing the swelling. As the X-ray neck was inconclusive a CT neck was taken which is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pharyngeal pouch", "correct": false}, {"label": "B", "text": "Laryngocele", "correct": true}, {"label": "C", "text": "Trachea-oesophageal fistula", "correct": false}, {"label": "D", "text": "Tonsillar", "correct": false}], "correct_answer": "B. Laryngocele", "question_images": ["https://image.prepladder.com/notes/qNEQnPRlq3f8E6N9qcBn1747983661.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 year old patient presented with Hoarseness of voice. On examination following finding shown below. What could be the diagnosis?", "options": [{"label": "A", "text": "Multinodular goiter", "correct": false}, {"label": "B", "text": "Secondaries neck", "correct": true}, {"label": "C", "text": "TB lymphadenitis", "correct": false}, {"label": "D", "text": "Sternomastoid tumor", "correct": false}], "correct_answer": "B. Secondaries neck", "question_images": ["https://image.prepladder.com/content/UCL2XKZSeLAzJhlwZ82e1713502982.png"], "explanation_images": ["https://image.prepladder.com/content/PxS57sHkXuVZJiyYxJX41713502960.png"], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p>Metastatic Neck Masses</p>\n</td>\n<td>\n<p>Enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes due to <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> from primary tumors</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the truth about the condition of a 40-year-old male teacher who presents with a complaint of hoarseness of voice for 5 months, worsening gradually, and is a non-smoker and social drinker? Laryngoscopic examination reveals nodules in the vocal cords.", "options": [{"label": "A", "text": "Laser therapy is the treatment of choice", "correct": false}, {"label": "B", "text": "It occurs at the junction of anterior 1/3 and posterior 2/3", "correct": true}, {"label": "C", "text": "Requires excision as its potentially malignant", "correct": false}, {"label": "D", "text": "Most common symptom is pain", "correct": false}], "correct_answer": "B. It occurs at the junction of anterior 1/3 and posterior 2/3", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: It occurs at the &lt;span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\"&gt;junction&lt;/span&gt; of &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;anterior&lt;/span&gt; 1/3 and &lt;span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\"&gt;posterior&lt;/span&gt; 2/3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following signs can be appreciated in the given X-ray?", "options": [{"label": "A", "text": "Steeple sign", "correct": false}, {"label": "B", "text": "String sign", "correct": false}, {"label": "C", "text": "Thumb sign", "correct": false}, {"label": "D", "text": "Double ring sign", "correct": true}], "correct_answer": "D. Double ring sign", "question_images": ["https://image.prepladder.com/content/CEgwGV6jTGGnffE2XjeK1724840155.png"], "explanation_images": ["https://image.prepladder.com/content/ZwfgRKOStu0la8s8C2fH1724840251.png", "https://image.prepladder.com/content/LnayeAZoJ6lOCGTMXGz91724840188.png", "https://image.prepladder.com/content/xbwlva2MYZiDXi4IocrJ1724840221.png"], "explanation": "<p>Correct Option D - Double ring sig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was presented to the OPD with a sudden onset of shortness of breath. Identify the condition with the radiological image given below.", "options": [{"label": "A", "text": "Epiglottitis", "correct": false}, {"label": "B", "text": "Laryngotracheobronchitis", "correct": true}, {"label": "C", "text": "Bronchitis", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": false}], "correct_answer": "B. Laryngotracheobronchitis", "question_images": ["https://image.prepladder.com/content/pXP0cG2CsnwVDGv6TPNg1741063322.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the provided chest X-ray, which of the following procedures would be most challenging to perform?", "options": [{"label": "A", "text": "Tracheostomy", "correct": true}, {"label": "B", "text": "Laryngeal Mask Airway (LMA) insertion", "correct": false}, {"label": "C", "text": "Ryle’s Tube (RT) insertion", "correct": false}, {"label": "D", "text": "Indirect laryngoscopy", "correct": false}], "correct_answer": "A. Tracheostomy", "question_images": ["https://image.prepladder.com/content/T1xlpx4viTNM6o8Hmj0B1724839949.png"], "explanation_images": ["https://image.prepladder.com/content/nH5qK6vhZ0QFeqc2iKdh1724839974.png"], "explanation": "<p>Correct Option A - Trach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with prolonged intubation complained of respiratory distress. Which of the following staging systems is used to stage the condition shown in the image?", "options": [{"label": "A", "text": "Cottom-Meyer classification", "correct": true}, {"label": "B", "text": "Radkowski classification", "correct": false}, {"label": "C", "text": "TNM classification", "correct": false}, {"label": "D", "text": "AJCC classification", "correct": false}], "correct_answer": "A. Cottom-Meyer classification", "question_images": ["https://image.prepladder.com/content/U5KgjNdbYs0bM5XGHCW41724839619.png"], "explanation_images": ["https://image.prepladder.com/content/i12AlUKikqFc1jZkcRvQ1724909139.png"], "explanation": "<p>Correct Option A - Cotton-M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A singer is finding difficulty in raising the pitch of her voice. On examination, her vocal cords were depressed and bowing. Which of the following muscles is involved?", "options": [{"label": "A", "text": "Cricothyroid", "correct": true}, {"label": "B", "text": "Interarytenoid", "correct": false}, {"label": "C", "text": "Posterior cricoarytenoid", "correct": false}, {"label": "D", "text": "Lateral arytenoid", "correct": false}], "correct_answer": "A. Cricothyroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cxe33Y09Y72fD22rPHeu1724839745.png"], "explanation": "<p>Correct Option A - Cricoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following stains can be used to identify a laryngeal mass during laryngeal examination?", "options": [{"label": "A", "text": "Congo red", "correct": false}, {"label": "B", "text": "Supravital stain", "correct": true}, {"label": "C", "text": "Silver nitrate", "correct": false}, {"label": "D", "text": "H and E", "correct": false}], "correct_answer": "B. Supravital stain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Suprav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statement is true regarding laryngomalacia?", "options": [{"label": "A", "text": "Expiratory stridor", "correct": false}, {"label": "B", "text": "Breathing Improves in supine position", "correct": false}, {"label": "C", "text": "Most common congenital abnormality in newborn", "correct": true}, {"label": "D", "text": "Surgical management is required in most children", "correct": false}], "correct_answer": "C. Most common congenital abnormality in newborn", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Laryngomalacia or <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> laryngeal stridor</p>\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> of the larynx.</li>\n<li>During inspiration, an excessively <span class=\"customMeta\" data-dictid=\"d28003a82c1692777202475273e346\">flaccid</span> <span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\">supraglottic</span> <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> gets sucked in and causes the symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Presents at birth or immediately after</li>\n<li>Stridor:\n\t\t\t\t<ul>\n<li><strong>Increases on crying</strong> (increased negative <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">intrathoracic</span> pressure pulls the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> inward, covering the laryngeal inlet)</li>\n<li><strong>Stridor present in <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> position</strong> (as the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> covers the laryngeal inlet)</li>\n<li><strong>Subsides in <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> position</strong> (as the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> falls away from the larynx)</li>\n</ul>\n</li>\n<li>Cyanosis seen sometimes</li>\n<li>Normal cry</li>\n<li>Usually disappears by 2 years of age</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations: </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct laryngoscopy:\n\t\t\t\t<ul>\n<li>Elongated epiglottis, curled upon itself giving an <strong>“omega-shaped” appearance</strong>.</li>\n<li>Floppy <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> folds</li>\n<li>Prominent aretynoids</li>\n</ul>\n</li>\n<li>Flexible <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">laryngoscopy</span> is the most preferred</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management: </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative treatment in most cases</li>\n<li>Tracheostomy: If severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> obstruction</li>\n<li>Supraglottoplasty: If severe laryngomalacia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old teacher presents to the physician with complaints of hoarseness and voice fatigue. She reports that these symptoms have been gradually worsening over the past few months, especially towards the end of the school day. She denies any history of smoking or excessive alcohol consumption. Flexible laryngoscopy image is given below. what is the diagnosis?", "options": [{"label": "A", "text": "Vocal nodule", "correct": true}, {"label": "B", "text": "Reinkes edema", "correct": false}, {"label": "C", "text": "Vocal polyp", "correct": false}, {"label": "D", "text": "Keratosis larynx", "correct": false}], "correct_answer": "A. Vocal nodule", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vocal <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">Nodule</span> (Singer or screamer's nodule)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic vocal abuse (teachers, actors, vendors or pop singers. )</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laterality </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral or symmetrical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location </strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Free edge of vocal cord at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 1/3rd and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> 2/3rd. This</p>\n<p>is the area of maximum <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> of the vocal cord.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sessile , Reddish in the early stage and white in the chronic stage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hoarseness, <span class=\"customMeta\" data-dictid=\"70f48cb1981692777202b78ba53214\">vocal fatigue</span> and neck pain on prolonged phonation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initially, voice rest.</li>\n<li>If it fails -</li>\n<li>microscopic <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> without injuring the vocal ligament</li>\n<li>Speech therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old child presents to the emergency department with a barking cough and noisy breathing. An anteroposterior view of x ray of the neck shows a steeple sign. What type of stridor is most commonly associated with this presentation?", "options": [{"label": "A", "text": "Inspiratory", "correct": false}, {"label": "B", "text": "Expiratory", "correct": false}, {"label": "C", "text": "Biphasic", "correct": true}, {"label": "D", "text": "Uniphasic", "correct": false}], "correct_answer": "C. Biphasic", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vitamin deficiency leads to Laryngismus stridulus?", "options": [{"label": "A", "text": "Vitamin K", "correct": false}, {"label": "B", "text": "Vitamin E", "correct": false}, {"label": "C", "text": "Vitamin D", "correct": true}, {"label": "D", "text": "Vitamin A", "correct": false}], "correct_answer": "C. Vitamin D", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Hypocalcemia (rickets, hypoparathyroidism)</li>\n<li>GERD</li>\n<li>Viral infections</li>\n<li>Allergies</li>\n<li>Stress/emotions</li>\n<li>Cold air, smoke</li>\n<li>Rare: neurological issues</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Sudden stridor</li>\n<li>Breath-holding</li>\n<li>Cough/choke</li>\n<li>Cyanosis</li>\n<li>Anxiety</li>\n<li>Normal between attacks</li>\n<li>No fever (unless infection)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Serum calcium, phosphate, vitamin D</li>\n<li>Chest X-ray</li>\n<li>Laryngoscopy (if needed)</li>\n<li>pH <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">probe</span> (for GERD)</li>\n<li>Allergy tests</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li><strong>Acute:</strong></li>\n<li>Calm child</li>\n<li>Humidified air</li>\n<li>Oxygen if needed</li>\n<li>Upright position</li>\n<li><strong>Underlying cause:</strong></li>\n<li>Correct calcium/vitamin D</li>\n<li>Treat GERD</li>\n<li>Avoid allergens</li>\n<li>Supportive care for infections</li>\n<li>Psychological support</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Adequate <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> (vitamin D, calcium)</li>\n<li>Manage triggers</li>\n<li>Parental education</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following symptoms is a 27-year-old female patient presenting with thyroid swelling is unlikely to experience due to compression of adjacent structures?", "options": [{"label": "A", "text": "Hoarseness of voice due to recurrent laryngeal nerve compression", "correct": false}, {"label": "B", "text": "Dysphagia due to oesophagus compression", "correct": false}, {"label": "C", "text": "Superior vena cava syndrome", "correct": false}, {"label": "D", "text": "None of the above", "correct": true}], "correct_answer": "D. None of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structures pass between structures passing between the superior and middle pharyngeal constrictor muscles.?", "options": [{"label": "A", "text": "Stylopharyngeus muscle and glossopharyngeal nerve", "correct": true}, {"label": "B", "text": "Internal laryngeal nerve and superior laryngeal artery", "correct": false}, {"label": "C", "text": "Recurrent laryngeal nerve", "correct": false}, {"label": "D", "text": "Ascending palatine artery", "correct": false}], "correct_answer": "A. Stylopharyngeus muscle and glossopharyngeal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vK6283Ir5und8SkofZ0D1717756009.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"bb47b0fb851692777199a25b3b83cd\"&gt;Stylopharyngeus muscle&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\"&gt;glossopharyngeal&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient comes with hoarseness of voice and difficulty swallowing. The patient was diagnosed with laryngeal carcinoma, and surgical management was done. The post-operative image of the patient is given below. Which of the following surgery was done on this patient?", "options": [{"label": "A", "text": "Partial laryngectomy", "correct": false}, {"label": "B", "text": "Percutaneous tracheostomy", "correct": false}, {"label": "C", "text": "Standard tracheostomy", "correct": false}, {"label": "D", "text": "Total laryngectomy", "correct": true}], "correct_answer": "D. Total laryngectomy", "question_images": ["https://image.prepladder.com/notes/yaTEqfvCu766x2sBRY4I1745909547.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following symptoms does a patient with Reinke's edema classically present with?", "options": [{"label": "A", "text": "Diplophonia", "correct": true}, {"label": "B", "text": "Dysphonia", "correct": false}, {"label": "C", "text": "Dysphagia of liquids more than solids", "correct": false}, {"label": "D", "text": "Dysphagia of solids more than liquids", "correct": false}], "correct_answer": "A. Diplophonia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pK9cMfI5DJqOih5zzITU1746424637.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who is a teacher by profession presents to the clinic with hoarseness of voice. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Vocal polyp", "correct": false}, {"label": "B", "text": "Vocal cyst", "correct": false}, {"label": "C", "text": "Vocal nodule", "correct": true}, {"label": "D", "text": "Reinke's oedema", "correct": false}], "correct_answer": "C. Vocal nodule", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/EtEJSmwy0vihnfyy8hFY1747390951.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vocal <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">Nodule</span> (Singer or screamer's nodule)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vocal Polyp</strong></p>\n<p><strong>(Option A)</strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic vocal abuse (teachers, actors, vendors or pop singers.)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden Vocal abuse like shouting (Men in the age group of 30-50 years).</li>\n<li>Heavy smoking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laterality </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral or symmetrical</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location </strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Free edge of vocal cord at the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 1/3rd and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> 2/3rd. This</p>\n<p>is the area of maximum <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> of the vocal cord.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Same as vocal nodules.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sessile , Reddish in the early stage and white in the chronic stage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smooth and pedunculated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hoarseness, <span class=\"customMeta\" data-dictid=\"70f48cb1981692777202b78ba53214\">vocal fatigue</span> and neck pain on prolonged phonation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hoarseness of voice and <span class=\"customMeta\" data-dictid=\"28f07d3bee1692777186c271b5856e\">diplophonia</span> (double voice due to different vibrating frequencies of two vocal cords)</li>\n<li>Large polyps- dyspnea, stridor, choking.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initially, voice rest.</li>\n<li>If it fails -</li>\n<li>microscopic <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> without injuring the vocal ligament</li>\n<li>Speech therapy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Microscopic excision</li>\n<li>Speech therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about laryngeal cancer stage T1bNOMO?", "options": [{"label": "A", "text": "Both vocal cords involved and fixed", "correct": false}, {"label": "B", "text": "Both vocal cords involved, and no metastasis", "correct": true}, {"label": "C", "text": "One vocal cord involved and metastasis", "correct": false}, {"label": "D", "text": "One vocal cord involved, and mobile", "correct": false}], "correct_answer": "B. Both vocal cords involved, and no metastasis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tumor is limited to one subsite of <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> with normal vocal cord mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of more than one adjacent subsites of <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> or <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> or region outside the <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> (e.g. <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of base of tongue, vallecula, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of <span class=\"customMeta\" data-dictid=\"7cdb5ed73b16927771966f6c4800de\">pyriform</span> sinus) without <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the larynx.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor is limited to the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space and/or minor <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> invasion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades through the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T4b</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tumor limited to vocal cord(s) (may involve <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> commissures) with normal mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T1a</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor is limited to one vocal cord.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T1b</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor involves both vocal cords.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor extends to <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> and/or subglottis, and/or with impaired vocal cord mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor is limited to the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> and/or invades paraglottic space and/or minor <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> erosion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T4a</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades through <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscles of the tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, thyroid, or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T4b</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tumor is limited to the subglottis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor extends to the vocal cord(s) with normal or impaired mobility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor limited to <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> with vocal cord fixation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> or <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and/or invades tissues beyond the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (e.g. trachea, soft tissues of neck including deep <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscle of tongue, <span class=\"customMeta\" data-dictid=\"ab1552f5491692777199e60c10b67f\">strap</span> muscles, <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> or esophagus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> space, encases the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or invades <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> structures.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, 3 cm or less in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node, more than 3 cm but not more than 6 cm in greatest dimension, or multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension, or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in the greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> more than 3 cm but not more than 6 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, none more than 6 cm in greatest dimension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Na</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metastasis in a <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> more than 6 cm in the greatest dimension</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mx</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No Distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following treatment options is not recommended for a 4-year-old boy presenting with low-grade fever, inspiratory stridor, and barking cough for the past 5 days? The examination shows a hoarse voice, a moderately inflamed pharynx, and a slightly increased respiratory rate. The chest x-ray reveals subglottic narrowing resembling a steeple.", "options": [{"label": "A", "text": "Nebulized racemic epinephrine", "correct": false}, {"label": "B", "text": "Parenteral cefotaxime", "correct": true}, {"label": "C", "text": "Helium oxygen mixture", "correct": false}, {"label": "D", "text": "Intramuscular dexamethasone", "correct": false}], "correct_answer": "B. Parenteral cefotaxime", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following signs suggests the presence of a high tracheostomy?", "options": [{"label": "A", "text": "Vocal cord palsy", "correct": false}, {"label": "B", "text": "Tracheomalacia", "correct": false}, {"label": "C", "text": "Foreign body obstruction", "correct": false}, {"label": "D", "text": "patients with total laryngectomy", "correct": true}], "correct_answer": "D. patients with total laryngectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zxREvnvk80lABrv0p62U1713502811.png"], "explanation": "<p>Correct Option D: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of lesions are associated with the presence of inspiratory stridor?", "options": [{"label": "A", "text": "Supraglottic", "correct": true}, {"label": "B", "text": "Subglottic", "correct": false}, {"label": "C", "text": "Tracheal", "correct": false}, {"label": "D", "text": "Bronchus", "correct": false}], "correct_answer": "A. Supraglottic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A. Inspiratory &lt;span class=\"customMeta\" data-dictid=\"c8af142f48169277719965c593fa0b\"&gt;stridor&lt;/span&gt; is commonly found in &lt;span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\"&gt;supraglottic&lt;/span&gt; lesions.\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Type of Stridor</strong></p>\n</td>\n<td>\n<p><strong>Origin</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory</p>\n</td>\n<td>\n<ul>\n<li>Supraglottic Lesions</li>\n<li>Pharynx</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expiratory</p>\n</td>\n<td>\n<p>Thoracic <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> and bronchi</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Biphasic</p>\n</td>\n<td>\n<ul>\n<li>Glottis</li>\n<li>Subglottis</li>\n<li>Cervical trachea</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lesion of vocal cord in the image given below:", "options": [{"label": "A", "text": "Reinke’s edema", "correct": false}, {"label": "B", "text": "Malignancy", "correct": false}, {"label": "C", "text": "Tracheomalacia", "correct": false}, {"label": "D", "text": "Laryngeal papilloma", "correct": true}], "correct_answer": "D. Laryngeal papilloma", "question_images": ["https://image.prepladder.com/content/OXBYqlhHfzCBcy9sBl5T1713502592.png"], "explanation_images": ["https://image.prepladder.com/content/nUegIkglAnjBmS9qSmYm1713502606.png"], "explanation": "<p>Correct option D. Laryngeal papilloma.</p>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Clinical Features</strong></p>\n</td>\n<td>\n<p><strong>Management Options</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Benign growth</p>\n</td>\n<td>\n<p>Regular monitoring of growth and symptoms</p>\n<p>Surgical removal of papillomas</p>\n<p>Adjuvant therapies such as laser treatment or cryotherapy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Caused by <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> infection</p>\n</td>\n<td>\n<p>Vaccination against <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> (for prevention)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Wart-like or grape-like projections</p>\n</td>\n<td>\n<p>Voice therapy and vocal cord exercises</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hoarseness</p>\n</td>\n<td>\n<p>Voice therapy and vocal cord exercises</p>\n<p>Surgical removal of papillomas</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stridor</p>\n<p>Breathing difficulties</p>\n</td>\n<td>\n<p>Airway management and emergency intervention</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the diagnosis for a 2-year-old child who has been experiencing fever, a cough that sounds like barking, and stridor for the past 2 days?", "options": [{"label": "A", "text": "Acute Epiglottitis", "correct": false}, {"label": "B", "text": "COVID-19", "correct": false}, {"label": "C", "text": "Adenoiditis", "correct": false}, {"label": "D", "text": "Acute laryngo tracheo bronchitis", "correct": true}], "correct_answer": "D. Acute laryngo tracheo bronchitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; laryngo tracheo bronchitis: </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical assessment based on symptoms such as the characteristic cough, stridor, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress. In severe cases, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies like neck <span class=\"customMeta\" data-dictid=\"6fda63a90c1692777202563d33a81b\">x-rays</span> or <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">laryngoscopy</span> may be performed.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.</p>\n<p><strong>Barking Cough:</strong></p>\n<p>A distinctive <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> that sounds like a seal or barking dog. 2.</p>\n<p><strong>Stridor:</strong></p>\n<p>High-pitched, inspiratory wheezing due to narrowed airways. 3.</p>\n<p><strong>Hoarseness:</strong></p>\n<p>Changes in the voice due to laryngeal involvement. 4.</p>\n<p><strong>Fever:</strong></p>\n<p>Often present, but usually low-grade. 5.</p>\n<p><strong>Respiratory Distress:</strong></p>\n<p>Rapid breathing, retractions (visible sinking of the chest or neck during inhalation), and difficulty breathing. 6.</p>\n<p><strong>Nasal Flaring:</strong></p>\n<p>In some cases, infants may exhibit <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> flaring.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Life-saving muscle of vocal cords is:", "options": [{"label": "A", "text": "Posterior cricoarytenoid", "correct": true}, {"label": "B", "text": "Lateral cricoarytenoid", "correct": false}, {"label": "C", "text": "Transverse arytenoid", "correct": false}, {"label": "D", "text": "Thyroarytenoid", "correct": false}], "correct_answer": "A. Posterior cricoarytenoid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\"&gt;Posterior&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Adam's apple seen in boys is because of:", "options": [{"label": "A", "text": "Hyoid bone", "correct": false}, {"label": "B", "text": "Tracheal rings", "correct": false}, {"label": "C", "text": "Thyroid cartilage", "correct": true}, {"label": "D", "text": "Cricoid cartilage", "correct": false}], "correct_answer": "C. Thyroid cartilage", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\"&gt;Thyroid&lt;/span&gt; cartilag\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adam's Apple</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The prominent <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> is more prominent in males due to hormonal and <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> differences, giving rise to the characteristic visible bulge known as the Adam's apple.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the initial signs of vocal fold growth?", "options": [{"label": "A", "text": "Cough", "correct": false}, {"label": "B", "text": "Change of voice", "correct": true}, {"label": "C", "text": "Fatigue voice", "correct": false}, {"label": "D", "text": "Pain", "correct": false}], "correct_answer": "B. Change of voice", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the structures that are not visible during indirect laryngoscopy?", "options": [{"label": "A", "text": "Anterior Commissure", "correct": true}, {"label": "B", "text": "Tracheal rings", "correct": false}, {"label": "C", "text": "Epiglottis", "correct": false}, {"label": "D", "text": "False Vocal Cord", "correct": false}], "correct_answer": "A. Anterior Commissure", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; Commissu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle in the larynx is essential for saving lives as it retracts the vocal cords to enable breathing?", "options": [{"label": "A", "text": "Cricothyroid", "correct": false}, {"label": "B", "text": "Posterior Cricoarytenoid", "correct": true}, {"label": "C", "text": "Lateral Cricoarytenoid", "correct": false}, {"label": "D", "text": "Transverse Arytenoid", "correct": false}], "correct_answer": "B. Posterior Cricoarytenoid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Larynx Muscle</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cricothyroid muscle</p>\n</td>\n<td>\n<p>Lengthens and tenses the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Posterior <span class=\"customMeta\" data-dictid=\"f54dba40a116927771859fc53d2f9f\">cricoarytenoid</span> muscle</p>\n</td>\n<td>\n<p>Abducts (opens) the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lateral <span class=\"customMeta\" data-dictid=\"f54dba40a116927771859fc53d2f9f\">cricoarytenoid</span> muscle</p>\n</td>\n<td>\n<p>Adducts (closes) the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Transverse <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> muscle</p>\n</td>\n<td>\n<p>Adducts (closes) the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thyroarytenoid muscle</p>\n</td>\n<td>\n<p>Shortens and relaxes the vocal cords, contributing to vocalization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vocalis muscle</p>\n</td>\n<td>\n<p>Controls tension and fine adjustments of the vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Interarytenoid muscles (Oblique and Transverse)</p>\n</td>\n<td>\n<p>Adducts (closes) the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part of the vocal cords</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All are parts of the Hypopharynx except:", "options": [{"label": "A", "text": "Posterior pharyngeal wall", "correct": false}, {"label": "B", "text": "Pyriform Sinus", "correct": false}, {"label": "C", "text": "Post cricoid area", "correct": false}, {"label": "D", "text": "Vallecula", "correct": true}], "correct_answer": "D. Vallecula", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following scenarios is high tracheostomy performed?", "options": [{"label": "A", "text": "Laryngeal papilloma", "correct": false}, {"label": "B", "text": "Carcinoma larynx", "correct": true}, {"label": "C", "text": "Bilateral vocal folds palsy", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": false}], "correct_answer": "B. Carcinoma larynx", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jezCndfGVWaHhGRLdaVn1714479637.png"], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The narrowest part of airway in an infant is:", "options": [{"label": "A", "text": "Supraglottis", "correct": false}, {"label": "B", "text": "Glottis", "correct": false}, {"label": "C", "text": "Subglottis", "correct": true}, {"label": "D", "text": "Epiglottis", "correct": false}], "correct_answer": "C. Subglottis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nwMjEVhYQ38RXnQrUSq31714479476.png"], "explanation": "<p>Correct Option C - Subg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which cartilage is responsible for the protrusion of the Adam's apple?", "options": [{"label": "A", "text": "Thyroid", "correct": true}, {"label": "B", "text": "Cricoid", "correct": false}, {"label": "C", "text": "Hyoid", "correct": false}, {"label": "D", "text": "Epiglottis", "correct": false}], "correct_answer": "A. Thyroid", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve injury is responsible for the development of postoperative aspiration in a patient who underwent surgery at the lateral part of the skull without any change in voice?", "options": [{"label": "A", "text": "High vagal injury", "correct": false}, {"label": "B", "text": "Recurrent laryngeal nerve", "correct": false}, {"label": "C", "text": "Superior laryngeal nerve", "correct": false}, {"label": "D", "text": "Glossopharyngeal nerve", "correct": true}], "correct_answer": "D. Glossopharyngeal nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"13b0890d441692777188afdcb41e75\"&gt;Glossopharyngeal&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable cause of surgical emphysema in a patient following an emergency tracheostomy?", "options": [{"label": "A", "text": "High tracheostomy", "correct": false}, {"label": "B", "text": "Tear in posterior tracheal wall", "correct": false}, {"label": "C", "text": "Block in tracheostomy", "correct": false}, {"label": "D", "text": "Tight suture around tracheostomy site", "correct": true}], "correct_answer": "D. Tight suture around tracheostomy site", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wohKFOB1i0KxA4VW4jCa1713502243.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What investigation is carried out immediately after a child is suspected of having inhaled a foreign body?", "options": [{"label": "A", "text": "Rigid bronchoscopy", "correct": false}, {"label": "B", "text": "Chest X-ray", "correct": true}, {"label": "C", "text": "Direct laryngoscopy", "correct": false}, {"label": "D", "text": "Flexible endoscopy", "correct": false}], "correct_answer": "B. Chest X-ray", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Chest X\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 62 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 16 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 16-year-old boy presents with a voice that sounds similar to that of a female, characterized by a high-pitched voice despite the completion of puberty. What could be a potential underlying cause related to the vocal cords for this condition?", "options": [{"label": "A", "text": "Immature growth of vocal cords leading to lengthening of vocal cords", "correct": false}, {"label": "B", "text": "Immature growth of vocal cords leading to relative shortening of vocal cords", "correct": true}, {"label": "C", "text": "Immature growth of vocal cords leading to incomplete closure of the anterior part of vocal cords", "correct": false}, {"label": "D", "text": "Immature growth of vocal cords leading to excessive thickening of vocal cords", "correct": false}], "correct_answer": "B. Immature growth of vocal cords leading to relative shortening of vocal cords", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ma05dDot076U3pGBrMTP1742805862.mp3", "video": ""}, {"text": "A 35-year-old teacher complains of hoarseness, vocal fatigue, and a weak voice, especially after prolonged speaking. Laryngoscopic examination reveals keyhole appearance of the glottis during phonation. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Puberphonia", "correct": false}, {"label": "B", "text": "Phonasthenia", "correct": true}, {"label": "C", "text": "Functional aphonia", "correct": false}, {"label": "D", "text": "Hysteric aphonia", "correct": false}], "correct_answer": "B. Phonasthenia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phonasthenia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Puberphonia</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Functional Aphonia</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hysteric Aphonia</strong></p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vocal fatigue due to weakness in the <span class=\"customMeta\" data-dictid=\"7bc832d5ba169277720012d171cc03\">thyroarytenoid</span> and <span class=\"customMeta\" data-dictid=\"470e25e266169277719072777c37e7\">interarytenoid</span> muscles causing vocal cord bowing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mutational falsetto with persistent high-pitched voice after puberty, more common in males</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Psychogenic voice disorder with loss of voluntary voice despite normal vocal cord structure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Conversion disorder with sudden voice loss due to psychological stress</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Weak, fatigued voice after speaking</li>\n<li><strong>Keyhole appearance of the glottis</strong> from vocal cord bowing</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High-pitched voice not congruent with age or gender</li>\n<li>Thin, weak voice quality</li>\n<li>No structural abnormalities in the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> or vocal cords</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Inability to produce voice voluntarily</li>\n<li>Able to <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> or whisper, indicating normal vocal cord function</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden inability to speak after emotional distress</li>\n<li>No organic <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> affecting the larynx</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laryngoscopic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keyhole appearance of the <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> from vocal cord bowing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>False vocal cord hypertrophy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vocal cords do not fully adduct during <span class=\"customMeta\" data-dictid=\"4af22cd2a8169277719558b4bb23fc\">phonation</span> but work normally during reflexive actions like coughing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vocal cords appear normal but may not come together during speech attempts. Patients can <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> or whisper</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Voice therapy to strengthen vocal muscles</li>\n<li>Thyroplasty for severe cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Voice Therapy: pitch adjustment through vocal techniques with a speech therapist.</li>\n<li>Type III Thyroplasty: Surgery to lower pitch by altering vocal cord tension.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Counseling and voice therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Psychological support and speech therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tqLFEkny9eSvEQLxCZZM1742807043.mp3", "video": ""}, {"text": "A patient is scheduled for surgery to remove a benign mass from the larynx. For direct laryngoscopy, which of the following positions is most preferred to provide optimal visualization and access to the larynx?", "options": [{"label": "A", "text": "Rose position", "correct": false}, {"label": "B", "text": "Fowler's position", "correct": false}, {"label": "C", "text": "Barking dog position", "correct": true}, {"label": "D", "text": "Supine neutral position", "correct": false}], "correct_answer": "C. Barking dog position", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tQiQQAinbZ0g6B1h7kMY1738572434.png", "https://image.prepladder.com/content/wofahqaLlwAr8hnkjf5U1738572511.png", "https://image.prepladder.com/content/Doy3AB1rYuMolbz72nu41738572530.png", "https://image.prepladder.com/content/RFmgLAmyXRZD6xjxR4Qh1738572540.png", "https://image.prepladder.com/content/26Ej9XiWxlogCC8trnwd1738572581.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infeasibility of <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">Indirect</span> <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">Laryngoscopy</span> (e.g. in infants/young children with symptoms suggesting laryngeal/hypopharyngeal pathology)</li>\n<li>Failure of <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">Indirect</span> <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">Laryngoscopy</span> (e.g. excessive <span class=\"customMeta\" data-dictid=\"9859613acd1692777187a2aaacae71\">gag</span> reflex, overhanging epiglottis)</li>\n<li>Examination of Hidden Areas (e.g. hypopharynx: base of tongue, valleculae, lower <span class=\"customMeta\" data-dictid=\"e7527c69f5169277719579acc480d4\">piriform</span> fossa; larynx: <span class=\"customMeta\" data-dictid=\"604985e2361692777190a81eb61544\">infrahyoid</span> epiglottis, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> commissure, ventricles, <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> region)</li>\n<li>Determining Extent and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">Biopsy</span> (e.g. to assess growths and obtain <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> samples)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Therapeutic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Removal of <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">Benign</span> Lesions (e.g., papillomas, fibromas, vocal nodules, polyps, cysts)</li>\n<li>Foreign Body <span class=\"customMeta\" data-dictid=\"00456bf7d8169277718782edf9fa2c\">Extraction</span> (from the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> and hypopharynx)</li>\n<li>Dilatation of Laryngeal Strictures</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Barking Dog Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rose Position</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supine (lying on the back), head in slight extension, chin elevated, neutral or slightly extended neck</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supine (lying on the back) with neck hyperextended, head in more pronounced extension, chin raised</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Use </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for laryngoscopy; provides a clear view of the <span class=\"customMeta\" data-dictid=\"427c7571fc1692777188fbb8492d21\">glottis</span> and vocal cords, ideal for intubation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used for <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> surgeries and other neck procedures; offers better exposure of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and surrounding structures.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7M5a2oqx0BxpMBJimtZm1742888364.mp3", "video": ""}, {"text": "During an indirect laryngoscopy, which of the following laryngeal structures is typically not visible?", "options": [{"label": "A", "text": "Vocal Cords", "correct": false}, {"label": "B", "text": "Pyriform Fossa", "correct": false}, {"label": "C", "text": "Arytenoid Cartilages", "correct": false}, {"label": "D", "text": "Anterior commisure", "correct": true}], "correct_answer": "D. Anterior commisure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Cs1ghGa3Cd8PglhTbsMJ1738572660.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Indirect Laryngoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Direct Laryngoscopy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Technique</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses a small laryngeal mirror and light source</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sarindam7\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Laryngeal_Mirror_ENT_Instrument_Medical.jpg\" data-tags=\"\" height=\"3000\" src=\"https://image.prepladder.com/content/Cs1ghGa3Cd8PglhTbsMJ1738572660.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uses a <span class=\"customMeta\" data-dictid=\"d8ef3b57ed16927771916f2e4afee8\">laryngoscope</span> with light and camera or lens</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" custommeta\"=\"\" data-author=\"Szilárd, Rendeki &amp; Keresztes, Dóra &amp; Woth, Gábor &amp; Mérei, Ákos &amp; Rozanovic M. D., Martin &amp; Rendeki, Mátyás &amp; Mühl, Diana &amp; Nagy, Balint. (2017). Comparison of VividTrac®, Airtraq®, King Vision®, Macintosh &lt;span class=\" data-dictid=\"d8ef3b57ed16927771916f2e4afee8\"/>Laryngoscope and a Custom-Made Videolaryngoscope for difficult and normal airways in mannequins by novices. BMC Anesthesiology. 17. 1-6. 10.1186/s12871-017-0362-y. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Evaluated-laryngoscopes-a-Direct-laryngoscope-Macintosh-b-VividTracR-c-Custom-made_fig1_317179007\" data-tags=\"\" height=\"3786\" src=\"https://image.prepladder.com/content/0P2IaAH2RwzeqkhEp1501738572670.png\" width=\"4167\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<br/>\n<br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visualization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reflective image of the larynx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct and detailed view of the larynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Visible</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epiglottis, <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> fold, false cords, true cords, <span class=\"customMeta\" data-dictid=\"7cdb5ed73b16927771966f6c4800de\">pyriform</span> fossa, postcricoid region, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall, <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"7b5f8e38321692777188a159fe5568\">glossoepiglottic</span> folds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete view of the larynx, including vocal cords, epiglottis, arytenoids, and other detailed structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Not Visible</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May not fully <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> commissure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No significant structures are missed in the larynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Routine examination of voice disorders and throat symptoms (primarily diagnostic)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> procedures, intubation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less invasive, quick, no specialized equipment needed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clear, detailed view, allows for interventions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Limitations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less detailed view, challenging in some <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> variations</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More invasive, requires <span class=\"customMeta\" data-dictid=\"b81cee1b5f16927771987099f651a0\">sedation</span> or anesthesia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Setting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Office or <span class=\"customMeta\" data-dictid=\"a9f32a257d1692777194caf3b4cf78\">outpatient</span> setting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Operating room or clinical setting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient Comfort</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generally well-tolerated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May cause discomfort, require <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> or sedation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aBTalQzYJ7TFQrvxLct01746644676.mp3", "video": ""}, {"text": "A 38-year-old male presents with a change of voice for 3 months and, on examination, is found to have unilateral superior laryngeal nerve paralysis that has no scope for improvement. Which of the following thyroplasty is recommended in this case?", "options": [{"label": "A", "text": "Type II", "correct": false}, {"label": "B", "text": "Type IV", "correct": false}, {"label": "C", "text": "Type III", "correct": false}, {"label": "D", "text": "Type I", "correct": true}], "correct_answer": "D. Type I", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zjnci26t41dDnJ7qLAOE1739259737.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:752px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type I/Medialization thyroplasty</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type II</strong></p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type III</strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type IV</strong></p>\n<p style=\"text-align:center\"><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is the <strong>medial </strong>displacement of the vocal cord using an <strong>implant </strong>placed in the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> via a window.</li>\n<li>Indications:\n\t\t\t\t<ul>\n<li><strong>Unilateral vocal cord paralysis</strong></li>\n<li>Bilateral bowed vocal cords due to aging</li>\n<li>Soft tissue defects of vocal cords</li>\n<li>Adductor palsy</li>\n<li><strong>Unilateral complete (recurrent &amp; superior laryngeal nerve) palsy</strong><br/>\n\t\t\t\t\t </li>\n</ul>\n</li>\n<li>A <strong>waiting period </strong>of <strong>12 months </strong>is necessary and <strong>injection <span class=\"customMeta\" data-dictid=\"ab25dbd10c1692777191430f81c6d9\">laryngoplasty</span> </strong>must be done during this time.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is <strong>lateral </strong>displacement of the vocal cord.</li>\n<li>Involves the <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of a <strong>shim </strong>to separate the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> vocal cords.</li>\n<li>Indication:\n\t\t\t\t<ul>\n<li><strong>Abductor palsy</strong></li>\n<li><strong>Bilateral <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve palsy</strong></li>\n</ul>\n</li>\n</ul>\n<p><br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to <strong>shorten </strong>(relax) the vocal cord</li>\n<li>This <strong>lowers </strong>the pitch</li>\n<li>Indications:\n\t\t\t\t<ul>\n<li><strong>Mutational falsetto/ Puberphonia </strong></li>\n<li><strong>Gender transformation </strong>surgery from female to male</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to <strong>lengthen </strong>(tighten) the vocal cord</li>\n<li>It <strong>elevates </strong>the pitch</li>\n<li>Indications:\n\t\t\t\t<ul>\n<li><strong>Androphonia </strong></li>\n<li>Gender transformation from <strong>male to female </strong></li>\n<li><strong>Lax vocal cord and bowing</strong> due to age or trauma</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Thyroplasty (or Isshiki’s thyroplasty)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P</strong>roximal/medialization of vocal cord</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <span class=\"customMeta\" data-dictid=\"bebdf1cab81692777180c37e36596c\">adductor</span> palsy, U/L complete VC palsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>La</strong>teralization of vocal cord</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">abductor</span> palsy, B/L RLN palsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>S</strong>hortening/relaxation of vocal cord</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For puberphonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ti</strong>ghtening/lengthening of vocal cord</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>For androphonia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bONg2Zx7bsagFMADfTR31742895276.mp3", "video": ""}, {"text": "A newborn baby presents with an inspirational stridor immediately after birth, which increases on crying. The stridor is alleviated when the baby is placed in the prone position, and the cry is normal. The flexible laryngoscopy is shown as follows.", "options": [{"label": "A", "text": "Congenital subglottic stenosis", "correct": false}, {"label": "B", "text": "Subglottic hemangioma", "correct": false}, {"label": "C", "text": "Laryngeal web", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": true}], "correct_answer": "D. Laryngomalacia", "question_images": ["https://image.prepladder.com/content/IQ656nTVrFeBiQ2z7sio1739259811.png"], "explanation_images": ["https://image.prepladder.com/content/ixQZfgTqitJ7cTGz5x691738573535.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Laryngomalacia or <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Laryngeal Stridor</strong></p>\n<ul>\n<li>Most common <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> of the larynx.</li>\n<li>During inspiration, an excessively <span class=\"customMeta\" data-dictid=\"d28003a82c1692777202475273e346\">flaccid</span> <span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\">supraglottic</span> <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> gets sucked in and causes the symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presents at birth or immediately after</li>\n<li>Stridor:\n\t\t\t\t<ul>\n<li><strong>Increases on crying</strong> (increased negative <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">intrathoracic</span> pressure pulls the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> inward, covering the laryngeal inlet)</li>\n<li><strong>Stridor present in <span class=\"customMeta\" data-dictid=\"b0976ea1fd16927771995d5c700a21\">supine</span> position</strong> (as the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> covers the laryngeal inlet)</li>\n<li><strong>Subsides in <span class=\"customMeta\" data-dictid=\"607476ab371692777196d0cb2f13bc\">prone</span> position</strong> (as the <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> falls away from the larynx)</li>\n</ul>\n</li>\n<li>Cyanosis seen sometimes</li>\n<li>Normal cry</li>\n<li>Usually disappears by 2 years of age</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Direct laryngoscopy:\n\t\t\t\t<ul>\n<li>Elongated epiglottis, curled upon itself giving an <strong>“omega-shaped” appearance</strong>.</li>\n<li>Floppy <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> folds</li>\n<li>Prominent aretynoids</li>\n</ul>\n</li>\n<li>Flexible <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">laryngoscopy</span> is the most preferred</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conservative treatment in most cases</li>\n<li>Tracheostomy: If severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> obstruction</li>\n<li>Supraglottoplasty: If severe laryngomalacia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yEnjjAol8gqRHg4wHJKQ1742895847.mp3", "video": ""}, {"text": "Which of the following statements about subglottic stenosis is true?", "options": [{"label": "A", "text": "Grade II presents with 71-99% obstruction", "correct": false}, {"label": "B", "text": "Grade I subglottis stenosis usually requires surgical intervention", "correct": false}, {"label": "C", "text": "A subglottic diameter of less than 4mm in a full-term neonate makes the diagnosis", "correct": true}, {"label": "D", "text": "The degree of strictures is measured by MRI", "correct": false}], "correct_answer": "C. A subglottic diameter of less than 4mm in a full-term neonate makes the diagnosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:711px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>The Myer-Cotton grading of <span class=\"customMeta\" data-dictid=\"f9f4c639501692777191cc78aa976a\">laryngotracheal</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Grade I: 0-50% obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade I <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> usually requires no <strong>surgical intervention. </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade II: 51-70% <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grade II <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> can be reconstructed by means of a <strong>laryngotracheal <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> </strong>(LTR).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Grade III: 71-99% obstruction<br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> III <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> repaired by <strong>anterior <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> </strong>with <strong>posterior <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> split +/- <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> grafting.</strong></li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> III <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> repaired by<strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> grafts</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Grade IV: 100% obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Grade IV <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> needs <strong>anterior and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> grafts</strong> with <strong>prolonged stenting.</strong></li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Partial cricotracheal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (PCTR)</strong> can be done for severe <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> III and <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> IV stenosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" custommeta\"=\"\" data-author=\"Vijayasekaran, Shyan. (2020). &lt;span class=\" data-dictid=\"318e52e4751692777195acbcdf4551\"/>Pediatric <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Pathology. Frontiers in Pediatrics. 8. 10.3389/fped.2020.00246. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Cotton-Meyer-Grading-of-Subglottic-Stenosis-a-Grade-I-50-obstruction-b-Grade-II_fig2_341920356\" data-tags=\"\" height=\"1277\" src=\"https://image.prepladder.com/content/y5toEjow55rfJa9V75Vf1738573640.png\" width=\"4167\" /&gt;\n\t\t\t<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fTtMAc60KhnwcHiKIkrH1742896469.mp3", "video": ""}, {"text": "A baby presents with biphasic stridor and severe respiratory obstruction necessitating intubation. Identify the false statement about this condition.", "options": [{"label": "A", "text": "Presents with a weak, high-pitched, squeaky voice", "correct": false}, {"label": "B", "text": "A CO2 laser is used in the endoscopic management of this condition", "correct": false}, {"label": "C", "text": "Commonly affects the glottis", "correct": false}, {"label": "D", "text": "The cry is normal in this condition", "correct": true}], "correct_answer": "D. The cry is normal in this condition", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GksM4mkSt6BjBEvPfm1n1738573787.png", "https://image.prepladder.com/content/Y54Dw31QE7leWaUzcQa31738573798.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laryngeal webs</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laryngeal webs are formed due to the <strong>failure of complete <span class=\"customMeta\" data-dictid=\"44966974da16927771833fe0743446\">canalization</span> of the larynx</strong> during embryogenesis.</li>\n<li>It leads to the formation of <strong>glottic</strong> <strong>(Option C) </strong>or, very rarely, a <span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\">supraglottic</span> web and causes variable degrees of <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and <span class=\"customMeta\" data-dictid=\"513e3f58591692777186180423ae9f\">dysphonia</span> as per the length of the vocal cord involved.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"861\" src=\"https://image.prepladder.com/content/GksM4mkSt6BjBEvPfm1n1738573787.png\" width=\"1294\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> obstruction</li>\n<li>Dysphonia</li>\n<li>Biphasic stridor</li>\n<li><strong>Weak</strong>, <strong>high</strong>-<strong>pitched</strong>, squeaky voice <strong>(Option A)</strong></li>\n<li><strong>Weak cry or <span class=\"customMeta\" data-dictid=\"1d9e09dbd11692777181b3a105e019\">aphonia</span> from birth </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Management</strong> (depends on <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of web)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Thin web: </strong>endoscopic division along the margin of one vocal cord with a <strong>knife </strong>or <strong>CO2 laser </strong><strong>(Option B)</strong><br/>\n\t\t\t\t </li>\n<li><strong>Thick web: </strong>excision via <span class=\"customMeta\" data-dictid=\"8ffcf0e5cd16927771914d50640320\">laryngofissure</span> and a <strong>silicon keel</strong> is placed endoscopically to prevent <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> for 2 weeks</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1632\" src=\"https://image.prepladder.com/content/Y54Dw31QE7leWaUzcQa31738573798.png\" width=\"1981\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/b1pyWkL9rtqa8r9i9wkd1746078899.mp3", "video": ""}, {"text": "A 4-month-old baby is having an inspiratory stridor that has worsened from the day of onset. An endoscopy is done and shows a compressible, pear-shaped red swelling in the subglottis on the left side. The baby also has a reddish lesion over her trunk. What is the first line of treatment for this condition?", "options": [{"label": "A", "text": "CO2 laser ablation", "correct": false}, {"label": "B", "text": "Intralesional steroid injection", "correct": false}, {"label": "C", "text": "Propranolol", "correct": true}, {"label": "D", "text": "Submucous resection", "correct": false}], "correct_answer": "C. Propranolol", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/d08wi2x7GyADT7X3eN8i1738573862.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PqaTmYNtW6FiWfDfQ6Bb1742898985.mp3", "video": ""}, {"text": "A 3-year-old child has stridor only during inspiration. Which of the following conditions is most likely responsible?", "options": [{"label": "A", "text": "Bronchial foreign body", "correct": false}, {"label": "B", "text": "Laryngeal papillomas", "correct": false}, {"label": "C", "text": "Retropharyngeal abscess", "correct": true}, {"label": "D", "text": "Subglottic stenosis", "correct": false}], "correct_answer": "C. Retropharyngeal abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZpiK5iTbJft9eSRpZWJb1739259943.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stridor </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>1. Inspiratory Stridor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>2. <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">Expiratory</span> Stridor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>3. <span class=\"customMeta\" data-dictid=\"d2d6148c9e16927771833a65ad15d2\">Biphasic</span> <span class=\"customMeta\" data-dictid=\"c8af142f48169277719965c593fa0b\">Stridor</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produced in obstructive lesions of <span class=\"customMeta\" data-dictid=\"4700baa9d2169277719994a0df242f\">supraglottis</span> or <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">pharynx</span> (extrathoracic obstruction).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produced in lesions of the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> trachea, primary and secondary <span class=\"customMeta\" data-dictid=\"4a371bd76e16927771835d6c738d1d\">bronchi</span> (intrathoracic obstruction).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Produced in lesions of glottis, <span class=\"customMeta\" data-dictid=\"d3c3b6066416927771998a86f25bc5\">subglottis</span> and <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> trachea.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>In <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">extrathoracic</span> obstruction: </strong></p>\n<p>During inspiration → <span class=\"customMeta\" data-dictid=\"d453c429fb16927771900c5cdf63d6\">intratracheal</span> pressure falls below <span class=\"customMeta\" data-dictid=\"52af0b13551692777182c93b65344d\">atmospheric pressure</span> → <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> collapse</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>In <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">intrathoracic</span> obstruction:</strong></p>\n<p>During <span class=\"customMeta\" data-dictid=\"2cbabc42d21692777187c451566867\">expiration</span> → elevated <span class=\"customMeta\" data-dictid=\"cfee4428321692777195b8d83946fe\">pleural pressure</span> compresses the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> → reduction in <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> size at the site of obstruction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>In glottic or <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> obstruction:</strong></p>\n<p>Airway segment → remains unchanged during respiration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Example </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laryngomalacia</li>\n<li>Retropharyngeal <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> <strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bronchial foreign body <strong>(Option A)</strong></li>\n<li>Tracheal stenosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laryngeal papillomas <strong>(Option B)</strong></li>\n<li>Vocal cord paralysis</li>\n<li>Subglottic <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LgA1CPRyaUW7k0Oqxfar1742899262.mp3", "video": ""}, {"text": "A 14-day-old neonate presents with stridor. Which condition is not typically associated with stridor in this age group?", "options": [{"label": "A", "text": "Epiglottitis", "correct": true}, {"label": "B", "text": "Choanal atresia", "correct": false}, {"label": "C", "text": "Intubation trauma", "correct": false}, {"label": "D", "text": "Vocal cord paralysis", "correct": false}], "correct_answer": "A. Epiglottitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Naso- and <span class=\"customMeta\" data-dictid=\"b1a011ab5416927771949dde193e3a\">Oropharyngeal</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Laryngeal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tracheal </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Congenital </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Choanal <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> (Option B)</strong></li>\n<li>Choanal stenosis</li>\n<li>Mid-nasal stenosis</li>\n<li>Pyriform <span class=\"customMeta\" data-dictid=\"31755c35251692777181caed228f5e\">aperture</span> stenosis</li>\n<li>Glioma</li>\n<li>Encephalocele</li>\n<li>Meningocele</li>\n<li>Dermoid/teratoma</li>\n<li>Craniofacial abnormalities</li>\n<li>Micrognathia- glossoptosis</li>\n<li>Lingual thyroid</li>\n<li>Lymphovascular malformation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Laryngomalacia<strong> </strong></li>\n<li><strong>Vocal cord <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (Option D)</strong></li>\n<li>Laryngeal stenosis</li>\n<li>Laryngeal cysts</li>\n<li>Webs</li>\n<li>Laryngeal atresia</li>\n<li>Vallecular cyst</li>\n<li>Arytenoid fixation</li>\n<li>Posterior laryngeal cleft</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tracheal stenosis</li>\n<li>Tracheal atresia</li>\n<li>Trapped first <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> ring</li>\n<li>Complete rings</li>\n<li>Micro (stovepipe) trachea</li>\n<li>Haemangioma</li>\n<li>Primary and secondary tracheomalacia- <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> compression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired - Neonates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neonatal rhinitis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Intubation trauma (Option C)</strong></li>\n<li>Surgical trauma (e.g. laser)</li>\n<li>Laryngeal stenosis</li>\n<li>Arytenoid fixation</li>\n<li>Reflux laryngitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Post-intubation/ instrumentation/ <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> stenosis</li>\n<li>Reflux tracheitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired - Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Allergic rhinitis</li>\n<li>Adenoiditis</li>\n<li>Adenotonsillar hypertrophy</li>\n<li>Foreign body</li>\n<li>Non-allergic rhinitis</li>\n<li>Retropharyngeal abscess</li>\n<li>Infectious mononucleosis</li>\n<li>Ludwig's angina</li>\n<li>Thermal and <span class=\"customMeta\" data-dictid=\"7a1df3740516927771839a820b0af0\">caustic</span> burns</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Intubation trauma</li>\n<li>Croup</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> papillomatosis</li>\n<li>Hereditary angioedema</li>\n<li>Epidermolysis bullosa</li>\n<li>Foreign body</li>\n<li>Dislocated arytenoid</li>\n<li><strong>Epiglottitis (Option A)</strong></li>\n<li>Trauma -fracture</li>\n<li>Caustic and <span class=\"customMeta\" data-dictid=\"e316517c941692777200eb2671128d\">thermal</span> burns</li>\n<li>Haemangioma</li>\n<li>Lymphovascular malformation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Croup</li>\n<li>Bacterial tracheitis</li>\n<li>Foreign body</li>\n<li>Localized <span class=\"customMeta\" data-dictid=\"933644fcb716927771918c1af06648\">malacia</span> secondary to a <span class=\"customMeta\" data-dictid=\"955bd148331692777200316f3d9855\">tracheostomy</span> or TOF repair</li>\n<li>Thyroid masses</li>\n<li>Lymphovascular malformation</li>\n<li>Mediastinal tumors</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wDxxJLih4lezaQMQBbpX1742899815.mp3", "video": ""}, {"text": "A 34-year-old patient presents to the emergency department with severe maxillofacial trauma. He cannot be intubated and is showing signs of hypoxia. What is the next best step?", "options": [{"label": "A", "text": "Bag-mask ventilation", "correct": false}, {"label": "B", "text": "Cricothyrotomy", "correct": true}, {"label": "C", "text": "Endotracheal intubation", "correct": false}, {"label": "D", "text": "Supraglottic airway device", "correct": false}], "correct_answer": "B. Cricothyrotomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HE1RSKEE02Y5RKf2jWkS1738574340.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cricothyrotomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Procedure for opening the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> through the <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> membrane.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Emergency <span class=\"customMeta\" data-dictid=\"b8770dd570169277718518d1bc84b0\">cricothyrotomy</span> is indicated in any<strong> </strong><strong>CICO (Cannot Intubate, Cannot Oxygenate)</strong><strong> </strong>scenario.</li>\n<li>Situations that may lead to CICO include:\n\t\t\t\t<ul>\n<li>Oral or <span class=\"customMeta\" data-dictid=\"5a65c3a2a11692777192222ab4b064\">maxillofacial</span> trauma</li>\n<li>Cervical spine trauma</li>\n<li>Profuse oral hemorrhage</li>\n<li>Copious emesis</li>\n<li>Anatomic abnormalities preventing <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> intubation</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Significance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cricothyrotomy is the final step in the difficult <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"0028f840571692777181e366182b99\">algorithm</span> for CICO scenarios.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Needle or Small Bore <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">Cannula</span> Cricothyrotomy:</strong></p>\n<ul>\n<li>A narrow-caliber rigid needle or flexible <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> is inserted through the <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> membrane.</li>\n<li>Limited for temporary use due to inadequate gas exchange, risking hypercarbia.</li>\n</ul>\n<p>2. <strong>Large <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">Cannula</span> Cricothyrotomy:</strong></p>\n<ul>\n<li>Cannula (&gt;4mm internal diameter) provides adequate <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> with standard breathing systems.</li>\n<li>Exhalation occurs through the cannula, even with complete upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction.</li>\n</ul>\n<p><strong>3. Surgical Cricothyrotomy:</strong></p>\n<ul>\n<li>Involves making a 3 cm midline incision, followed by a <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> in the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> part of the <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">cricothyroid</span> membrane, and the <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of a 6mm tube.</li>\n<li>Cricothyrotomy tubes should be converted to tracheostomies within a few days to prevent <span class=\"customMeta\" data-dictid=\"513e3f58591692777186180423ae9f\">dysphonia</span> and <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> stenosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bleeding</li>\n<li>Lacerations of <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> cartilage</li>\n<li>Perforation of the trachea</li>\n<li>Creation of a false tract</li>\n<li>Infection</li>\n<li>Long-term complications: <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">Subglottic</span> stenosis, Voice change</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contraindications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>No absolute contraindications in CICO scenarios.</li>\n<li>Relative contraindications:\n\t\t\t\t<ul>\n<li>Known <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> surgery</li>\n<li>Fractured larynx</li>\n<li>Laryngotracheal disruption</li>\n<li>Children</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/HE1RSKEE02Y5RKf2jWkS1738574340.png\" width=\"4167\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tB3Bo2bmcscj9m7zOqkl1742980723.mp3", "video": ""}, {"text": "A 60-year-old patient with severe asthma and airway edema is admitted to the ICU after multiple failed intubation attempts. Which type of procedure is most suitable for ensuring long-term airway management?", "options": [{"label": "A", "text": "High tracheostomy", "correct": false}, {"label": "B", "text": "Low tracheostomy", "correct": false}, {"label": "C", "text": "Mid tracheostomy", "correct": true}, {"label": "D", "text": "Cricothyrotomy", "correct": false}], "correct_answer": "C. Mid tracheostomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/L52Lgl1eT5eyxGVGowKy1738574591.png", "https://image.prepladder.com/content/dJxQ6PyHsp85zBDx8Rb71738574602.png", "https://image.prepladder.com/content/aPbaMBsAFDKhdDsvlGhY1738574701.png", "https://image.prepladder.com/content/XBB1hzCZ48hQ5pZlUsVU1738574528.png", "https://image.prepladder.com/content/lKnSCycKK8t1qDwHIf701739260122.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:618px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>High <span class=\"customMeta\" data-dictid=\"955bd148331692777200316f3d9855\">Tracheostomy</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mid-Tracheostomy</strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Low Tracheostomy</strong></p>\n<p style=\"text-align:center\"><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location: </strong>Done above the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> (isthmus lies against 1st, 2nd, and 4th <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> rings) and involves the 1st <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> ring.</li>\n<li><strong>Risks: </strong>Perichondritis of <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> stenosis.</li>\n<li><strong>Only Indication: </strong>Carcinoma of the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> (since the entire <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> will be removed, and a new tracheostome will be made lower).</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location: </strong>Done through the 2nd or 3rd <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> rings and involves the division of or <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> to expose the trachea.</li>\n<li> </li>\n<li><strong>Most Preferred technique</strong></li>\n<li>The procedure</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Location: </strong>Done below the level of <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"290782db561692777190e9766fc8ae\">isthmus</span> (below the 3rd <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> ring).</li>\n<li><strong>Challenges:</strong>\n<ul>\n<li>Trachea is deeper at this level.</li>\n<li>Close proximity to large blood vessels.</li>\n<li>Difficulty with <span class=\"customMeta\" data-dictid=\"955bd148331692777200316f3d9855\">tracheostomy</span> tube impinging on the <span class=\"customMeta\" data-dictid=\"751ea5589f1692777199db9f2ec233\">suprasternal</span> notch.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1955\" src=\"https://image.prepladder.com/content/L52Lgl1eT5eyxGVGowKy1738574591.png\" width=\"2177\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1848\" src=\"https://image.prepladder.com/content/dJxQ6PyHsp85zBDx8Rb71738574602.png\" width=\"2267\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1990\" src=\"https://image.prepladder.com/content/aPbaMBsAFDKhdDsvlGhY1738574701.png\" width=\"2355\"/></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author='Klaus D. Peter, Wiehl, Germany Diese Datei aus meinem Archiv habe ich unter der „Creative-Commons-Lizenz“ veröffentlicht. Ich bin dankbar, wenn Sie mir die Verwendung der Datei unter klausdpeter@gmail.com anzeigen. I have published this file under a \"Creative Commons License\". Thank you for your email to klausdpeter@gmail.com in case of using this picture' data-hash=\"\" data-license=\"CC BY-3.0 de\" data-source=\"https://en.wikipedia.org/wiki/Tracheotomy#/media/File:Tracheostomy_tube.jpg\" data-tags=\"\" height=\"3214\" src=\"https://image.prepladder.com/content/XBB1hzCZ48hQ5pZlUsVU1738574528.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"National Heart Lung and Blood Institute (NIH)\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Tracheotomy#/media/File:Tracheostomy_NIH.jpg\" data-tags=\"\" height=\"2266\" src=\"https://image.prepladder.com/content/lKnSCycKK8t1qDwHIf701739260122.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tzUn8S7xJU7ZimvhnYtU1742981614.mp3", "video": ""}, {"text": "A 70-year-old woman in need of long-term airway maintenance was treated by tracheostomy. The tracheostomy tube has developed a partial obstruction in the following days. Which of the following steps is not necessary to manage this situation?", "options": [{"label": "A", "text": "Decannulation and reintubation", "correct": true}, {"label": "B", "text": "Suctioning with sterile catheters", "correct": false}, {"label": "C", "text": "Humidification and saline instillation", "correct": false}, {"label": "D", "text": "Administering mucolytics", "correct": false}], "correct_answer": "A. Decannulation and reintubation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/s838kWLtUdKnzDdFZO9N1742981822.mp3", "video": ""}, {"text": "A 5-year-old child presents with complete airway obstruction after swallowing a coin and is showing signs of hypoxia. The Heimlich maneuver has failed. X-rays of the neck are shown below. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Use of a dormia basket", "correct": false}, {"label": "B", "text": "Perform emergency tracheostomy", "correct": true}, {"label": "C", "text": "Attempt direct laryngoscopy and removal", "correct": false}, {"label": "D", "text": "Initiate advanced airway management with intubation", "correct": false}], "correct_answer": "B. Perform emergency tracheostomy", "question_images": ["https://image.prepladder.com/content/jJRjgfHqEIvV4sN3IOfV1738574976.png"], "explanation_images": ["https://image.prepladder.com/content/J7lW26ZnCm4roqLbWHks1738575161.png", "https://image.prepladder.com/content/6m07BppYdw0CwAWCY4VL1738575175.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tracheal Foreign Body</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laryngeal Foreign Body</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sharp Foreign Body: </strong>Cough and hemoptysis.</li>\n<li><strong>Loose Foreign Body (e.g., seed): </strong>May move between <span class=\"customMeta\" data-dictid=\"471f9b6bf1169277718387418e5d06\">carina</span> and vocal cords, causing:\n\t\t\t\t<ul>\n<li>\"Audible slap\" and \"palpatory thud\"</li>\n<li>Asthmatoid <span class=\"customMeta\" data-dictid=\"c804829f4416927772026f34ff3e31\">wheeze</span> heard best at patient’s open mouth</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Complete Obstruction: </strong>Can cause <span class=\"customMeta\" data-dictid=\"bc3e3350401692777182edb342a55b\">asphyxia</span> and sudden death unless urgent resuscitative measures are taken urgently.</li>\n<li><strong>Partial Obstruction: </strong>Cause discomfort or pain in throat, hoarseness, stridor, cough, aphonia, dyspnea, wheezing, and hemoptysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology: Soft Tissue X-ray: </strong>PA and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> views of neck in its extended position for radio-opaque and sometimes <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> foreign body in larynx/trachea.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Emergency removal of foreign bodies is not typically indicated unless:\n\t\t\t\t<ul>\n<li>Airway <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> is present.</li>\n<li>Foreign bodies are of vegetable origin (e.g., seeds) and likely to swell.</li>\n</ul>\n</li>\n<li><strong>Methods for Foreign Body Removal</strong></li>\n</ul>\n<ol>\n<li><strong>Rigid bronchoscopy.</strong></li>\n<li>Bronchoscopy with C-arm fluoroscopy.</li>\n<li>Use of <span class=\"customMeta\" data-dictid=\"cfd89144501692777186f8dc288708\">Dormia basket</span> or Fogarty's balloon for rounded objects. <strong>(Option A)</strong></li>\n<li>Tracheostomy first followed by <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> through the tracheostome.</li>\n<li>Thoracotomy and <span class=\"customMeta\" data-dictid=\"5a1a0f0ac51692777183f8ce68c49f\">bronchotomy</span> for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> foreign bodies.</li>\n<li>Flexible <span class=\"customMeta\" data-dictid=\"7d6b7691751692777202a16425cf28\">fiberoptic</span> <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> in selected adult patients.</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete Obstruction:</strong></p>\n<ul>\n<li>A large <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> of food above the vocal cords may cause total <span class=\"customMeta\" data-dictid=\"1d9e09dbd11692777181b3a105e019\">aphonia</span> (inability to cry for help).</li>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"edfeba77ac1692777202dfbaf4a0f7\">First Aid</span> Measures:\n\t\t\t\t<ul>\n<li>Back pounding.</li>\n<li>Turn the patient upside down.</li>\n<li><strong>Back Blows (for infants &lt;1 year): </strong>Place the infant face down over the rescuer’s arm, head lower than the trunk, and deliver five back blows between the scapulae.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Luba Lee, FNP-BC, MS\" data-hash=\"\" data-license=\"CC BY-NC SA 3.0\" data-source=\"https://www.wikihow.life/Do-First-Aid-on-a-Choking-Baby\" data-tags=\"\" height=\"3862\" src=\"https://image.prepladder.com/content/J7lW26ZnCm4roqLbWHks1738575161.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Heimlich <span class=\"customMeta\" data-dictid=\"220efc126c169277719138aa9a5537\">Maneuver</span> (for &gt;1 year):</strong>\n<ul>\n<li>Should not be done if only partial obstruction, for fear of causing total obstruction</li>\n<li>Procedure: Stand behind the patient and wrap arms around the lower chest.</li>\n<li>Perform four <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> thrusts to use <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> air in the lungs to dislodge the foreign body.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"US ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL FORT SAM HOUSTON, TEXAS 78234-6100 - https://www.militarynewbie.com/wp-content/uploads/2013/11/US-Army-medical-course-Cardiopulmonary-Resuscitation-CPR-MD0532.pdf\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Abdominal_thrusts#/media/File:AbdominalThrust_HeimlichManoeuvre.svg\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/6m07BppYdw0CwAWCY4VL1738575175.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>If Heimlich fails:</strong> Perform <span class=\"customMeta\" data-dictid=\"b8770dd570169277718518d1bc84b0\">cricothyrotomy</span> or emergency <span class=\"customMeta\" data-dictid=\"955bd148331692777200316f3d9855\">tracheostomy</span> to secure the airway. <strong>(Option B)</strong></li>\n<li><strong>Post-Emergency:</strong> Foreign body removal using <span class=\"customMeta\" data-dictid=\"55ab22c1db16927771863a11870e68\">direct laryngoscopy</span> or <span class=\"customMeta\" data-dictid=\"8ffcf0e5cd16927771914d50640320\">laryngofissure</span> if the object is impacted. <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tGRn72kqCJheGrRndiNr1746078778.mp3", "video": ""}, {"text": "A 3-year-old presents with sudden coughing and wheezing after eating peanuts. A chest X-ray is taken and shown below. What is the most likely type of bronchial obstruction?", "options": [{"label": "A", "text": "Total obstruction", "correct": false}, {"label": "B", "text": "Partial obstruction", "correct": false}, {"label": "C", "text": "Bilateral obstruction", "correct": false}, {"label": "D", "text": "One-way (check valve) obstruction", "correct": true}], "correct_answer": "D. One-way (check valve) obstruction", "question_images": ["https://image.prepladder.com/content/rAdoCFHP9xQYFbrrMlGw1738575332.png"], "explanation_images": ["https://image.prepladder.com/content/HZac7sTjliA1qnHFisRS1738575394.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right bronchus</strong> (due to its wider <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> and <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> with the trachea)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cough, wheezing, and diminished air entry to the lung.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Late Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lung collapse, emphysema, pneumonitis, bronchiectasis, or lung abscess.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types of Obstruction</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"2240\" src=\"https://image.prepladder.com/content/HZac7sTjliA1qnHFisRS1738575394.png\" width=\"1827\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Partial Obstruction: (Option B)</strong>\n<ul>\n<li>Air can pass in and out</li>\n<li>Cause only wheezing</li>\n</ul>\n</li>\n<li><strong>One-way Obstruction: (Option D)</strong>\n<ul>\n<li>Air can enter (during inspiration) but not exit</li>\n<li>Cause <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> of the lungs</li>\n</ul>\n</li>\n<li><strong>Total Obstruction: (Option A)</strong>\n<ul>\n<li>Air cannot enter or exit</li>\n<li>Cause obstructive atelectasis</li>\n</ul>\n</li>\n<li><strong>One-way <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (reverse of B): </strong>\n<ul>\n<li>Air can exit (during expiration) but not enter</li>\n<li>Cause atelectasis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Obstructive Emphysema: </strong>Air trapped in the lungs due to a check-valve mechanism.</li>\n<li><strong>Spontaneous Pneumothorax: </strong>Due to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of emphysematous bullae.</li>\n<li><strong>Lung Collapse: </strong>Due to complete bronchial obstruction.</li>\n<li><strong>Chronic Complications:</strong> Retained foreign bodies may lead to pneumonitis, bronchiectasis, or lung abscess.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Plain <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> Chest (PA and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Views):</strong></li>\n</ul>\n<ul>\n<li><strong>Fluoroscopy/Videofluoroscopy: </strong>Evaluation during inspiration and <span class=\"customMeta\" data-dictid=\"2cbabc42d21692777187c451566867\">expiration</span> can be made.</li>\n<li><strong>CT Chest</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Emergency removal of foreign bodies is not typically indicated unless:\n\t\t\t\t<ul>\n<li>Airway <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> is present.</li>\n<li>Foreign bodies are of vegetable origin (e.g., seeds) and are likely to swell.</li>\n</ul>\n</li>\n<li><strong>Methods for Foreign Body Removal:</strong></li>\n</ul>\n<ol>\n<li>Conventional rigid bronchoscopy.</li>\n<li>Rigid <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> with telescopic aid.</li>\n<li>Bronchoscopy with C-arm fluoroscopy.</li>\n<li>Use a <span class=\"customMeta\" data-dictid=\"cfd89144501692777186f8dc288708\">Dormia basket</span> or Fogarty's balloon for rounded objects.</li>\n<li>Tracheostomy first followed by <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> through the tracheostome.</li>\n<li>Thoracotomy and <span class=\"customMeta\" data-dictid=\"5a1a0f0ac51692777183f8ce68c49f\">bronchotomy</span> for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> foreign bodies.</li>\n<li>Flexible <span class=\"customMeta\" data-dictid=\"7d6b7691751692777202a16425cf28\">fiberoptic</span> <span class=\"customMeta\" data-dictid=\"f8d4c5c1c01692777183ee445dc295\">bronchoscopy</span> in selected adult patients.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lxnMvSVAUCGyM2MIEK9y1742900232.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 26 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 8 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Apart from the abdominal cavity, which body part is included in e-FAST?", "options": [{"label": "A", "text": "Pelvic Cavity", "correct": false}, {"label": "B", "text": "Peripheral vessels", "correct": false}, {"label": "C", "text": "Thoracic cavity", "correct": true}, {"label": "D", "text": "Dural and subdural spaces", "correct": false}], "correct_answer": "C. Thoracic cavity", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to GCS, a verbal score of 1 indicates:", "options": [{"label": "A", "text": "No Verbal response", "correct": true}, {"label": "B", "text": "Inappropriate words", "correct": false}, {"label": "C", "text": "Incomprehensible sounds", "correct": false}, {"label": "D", "text": "Oriented response", "correct": false}], "correct_answer": "A. No Verbal response", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Simplified Glasgow <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">Coma</span> Scale (GCS) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5 <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common site of peripheral aneurysm?", "options": [{"label": "A", "text": "Brachial artery", "correct": false}, {"label": "B", "text": "Popliteal artery", "correct": true}, {"label": "C", "text": "Radial artery", "correct": false}, {"label": "D", "text": "Femoral artery", "correct": false}], "correct_answer": "B. Popliteal artery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is absent in cases of massive blood transfusion?", "options": [{"label": "A", "text": "DIC", "correct": false}, {"label": "B", "text": "Febrile transfusion reaction", "correct": false}, {"label": "C", "text": "Hypercalcemia", "correct": true}, {"label": "D", "text": "Thrombocytopenia", "correct": false}], "correct_answer": "C. Hypercalcemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:682px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complications of massive blood transfusion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transfusion of cold blood (stored at 4°C).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Body temperature drops, leading to impaired <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> mechanisms (coagulopathy), and worsening bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coagulopathy</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilution of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors and platelets due to transfusion; consumption of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors by ongoing haemorrhage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired blood clotting, prolonged <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> time, thrombocytopenia, and increased risk of continued bleeding.</p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DIC</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to the release of <span class=\"customMeta\" data-dictid=\"ff2094828c1692777196941a65e6eb\">procoagulant</span> substances</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leads to haemorrhage due to depleted <span class=\"customMeta\" data-dictid=\"7414bd02f216927771889b3e159ef4\">hemostatic</span> components, tissue hypoxia, and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> due to microthrombi, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Citrate Toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large volumes of transfused blood contain citrate, which binds to calcium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypocalcemia leads to muscle cramps, seizures, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypocalcemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Packed red blood cells (PRBCs) and other blood products are preserved with <strong>citrate</strong>, an anticoagulant.</li>\n<li>Citrate binds to <strong>ionised calcium</strong> (Ca²⁺) in the recipient's blood, reducing the free <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> level - <strong>hypocalcemia</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presents as muscle spasms, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, and decreased myocardial contractility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium leaks from stored red blood cells into <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels (hyperkalemia) can cause <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, potentially leading to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypokalemia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium may shift intracellularly once transfused red blood cells are metabolically revived.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypokalemia causes muscle weakness, paralysis, and <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> of <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> into bicarbonate.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased pH (alkalosis) can lead to muscle twitching, irritability, and impaired oxygen release from haemoglobin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inadequate tissue <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> leads to <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid accumulation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lowered blood pH (acidosis) leads to confusion, fatigue, rapid breathing, and worsened <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Related <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Lung Injury (TRALI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibodies in transfused blood <span class=\"customMeta\" data-dictid=\"dddc752e1716927771807f985bb8bb\">activate</span> the recipient's immune response, causing <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and fluid buildup in the lungs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema, presenting as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> with <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> within 6 hours of transfusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transfusion Associated Circulatory <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">Overload</span> (TACO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Volume of transfused blood exceeds the patient’s capacity to manage, leading to fluid overload.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary oedema, shortness of breath, hypertension, and signs of heart failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron Overload</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeated transfusions lead to excessive accumulation of iron.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iron deposits in organs (e.g., liver, heart, pancreas), lead to organ damage and failure over time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolytic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ABO or Rh incompatibility.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid destruction of red blood cells (hemolysis), causes fever, chills, hemoglobinuria, and potentially <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure or shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Allergic Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reaction to proteins in transfused blood products.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms range from mild itching, rash, or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> to severe <span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\">anaphylaxis</span> (airway constriction, low blood pressure, shock).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacterial Contamination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood products are contaminated during collection or storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sepsis, characterized by fever, chills, low blood pressure, and possibly <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Febrile <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> reaction</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a non-hemolytic condition that is not completely understood but is believed to be caused by <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> white blood cells in the blood unit or cytokines that accumulate during storage.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fever, rigour, chills</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about ranula is FALSE?", "options": [{"label": "A", "text": "Mucus extravasation cyst", "correct": false}, {"label": "B", "text": "Arises from submandibular salivary gland", "correct": true}, {"label": "C", "text": "Bluish, translucent cystic swelling on the floor of the mouth", "correct": false}, {"label": "D", "text": "Marsupialization or excision is the treatment", "correct": false}], "correct_answer": "B. Arises from submandibular salivary gland", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/akYmkU4Zg2U6E2ZO9wmY1747024988.png", "https://image.prepladder.com/content/GNogQfMmb7mub03r2GvM1747024988.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Ranula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n<p><strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Ranulas are a type of <strong>extravasation mucocele</strong>, caused by the <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of the main <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> or obstructed <span class=\"customMeta\" data-dictid=\"4e0948603216927771801829c2c085\">acini</span> of the <strong>sublingual gland</strong>.</li>\n<li>They appear as <strong>bluish, translucent, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> on the floor of the mouth</strong> and resemble the belly of a frog.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Ph0t0happy\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Ranula_human_09.jpg\" data-tags=\"\" height=\"513\" src=\"https://image.prepladder.com/content/akYmkU4Zg2U6E2ZO9wmY1747024988.png\" width=\"573\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Commonly found in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> floor of the mouth.</li>\n<li>When it extends through the <span class=\"customMeta\" data-dictid=\"d0922475bc1692777193d420470423\">mylohyoid</span> muscle, it presents as a <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> known as a<strong> \"plunging ranula.\"</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Typically soft, fluctuant, and painless unless infected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Confirmed through Magnetic Resonance Imaging (MRI)</li>\n<li>Ultrasound</li>\n<li>Aspiration of thick, sticky <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> differentiates it from a lymphangioma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Excision of the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> is preferred. </strong></li>\n<li>Incision, drainage, and marsupialisation have low success rates. Although <strong>marsupialisation</strong> is often adequate, it has a higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rate compared to <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> excision.</li>\n<li>OK-432 injection</li>\n<li>Botulinum <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> injections</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"534\" src=\"https://image.prepladder.com/content/GNogQfMmb7mub03r2GvM1747024988.png\" width=\"534\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who is taking steroids for psoriasis and is experiencing a low-grade fever only at night, weight loss, and an ulcer on her neck with undermined edges, as depicted in the provided image?", "options": [{"label": "A", "text": "Psoriasis flare-up", "correct": false}, {"label": "B", "text": "Tubercular lymphadenitis", "correct": true}, {"label": "C", "text": "Lymphosarcoma", "correct": false}, {"label": "D", "text": "Syphilis", "correct": false}], "correct_answer": "B. Tubercular lymphadenitis", "question_images": ["https://image.prepladder.com/notes/1TH1dju86skmeaqbBBxB1747998760.png"], "explanation_images": ["https://image.prepladder.com/content/fEc4u0perN8HZQL6yWkS1747025426.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> TB (Tuberculous Lymphadenitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Most common</strong> <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> TB presentation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Groups</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HIV-positive individuals, Immunosuppressive individuals, children, and non-Caucasian women.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Previously M. bovis; now mainly M. tuberculosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Painless </strong>swelling in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, usually <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> or <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> (historically called scrofula).</li>\n<li><strong>Early disease: Discrete nodes</strong></li>\n<li>Advanced disease: Matted, nontender mass, possible <span class=\"customMeta\" data-dictid=\"10df63cea41692777203b470341d21\">fistula</span> draining <span class=\"customMeta\" data-dictid=\"99368d5fef1692777183ea405bed67\">caseous</span> material.</li>\n<li>Pulmonary disease in &lt;50% of cases.</li>\n<li>Systemic symptoms are uncommon except in HIV-positive patients.</li>\n<li>Non-specific reaction → Matting → Cold <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> → Collar stud <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> → Sinus formation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fine-needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (80% yield) or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> biopsy.</strong></li>\n<li>Granulomatous lesions may or may not contain AFBs.</li>\n<li>Cultures are positive in 70–80% of cases.</li>\n<li>HIV-positive patients: Poorly organised or absent granulomas; higher bacterial loads increase <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> yield.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infectious diseases</li>\n<li>Lymphomas</li>\n<li>Metastatic carcinomas</li>\n<li>Rare disorders: Kikuchi’s disease, Kimura’s disease, Castleman’s disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman comes to the OPD with a history of a lump in the left breast. On clinical examination, the size of the lump in the left breast is 9x10 cm with the following appearance and no axillary lymphadenopathy. The histopathology of the biopsy from the lump shows increased stromal cellularity and typical leaflike architecture. What is your likely diagnosis?", "options": [{"label": "A", "text": "Phyllodes tumour", "correct": true}, {"label": "B", "text": "Giant fibroadenoma", "correct": false}, {"label": "C", "text": "Inflammatory carcinoma", "correct": false}, {"label": "D", "text": "Ductal carcinoma", "correct": false}], "correct_answer": "A. Phyllodes tumour", "question_images": ["https://image.prepladder.com/content/d79JUMsTq9YVRORpAoQE1747116110.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis from the given abdominal x-ray?", "options": [{"label": "A", "text": "Ureterocoele", "correct": false}, {"label": "B", "text": "Pelvic bone fracture", "correct": false}, {"label": "C", "text": "Rectal foreign body", "correct": true}, {"label": "D", "text": "Bladder stone", "correct": false}], "correct_answer": "C. Rectal foreign body", "question_images": ["https://image.prepladder.com/content/MyC6v9qsXI7vAK7gc0TR1748163282.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 18 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 15 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 45-year-old patient is experiencing persistent headaches and frontal sinus pain. A radiograph is taken with the patient in a chin-down position to assess the involvement of the frontal sinus. What is this imaging view called?", "options": [{"label": "A", "text": "Waters' View", "correct": false}, {"label": "B", "text": "Pierre’s View", "correct": false}, {"label": "C", "text": "Caldwell View", "correct": true}, {"label": "D", "text": "Lateral View", "correct": false}], "correct_answer": "C. Caldwell View", "question_images": ["https://image.prepladder.com/content/Oyecc5Hu8mVIZamFZr9m1738563608.png"], "explanation_images": ["https://image.prepladder.com/content/3EJelKvEOJZWTbqsTy9C1738563707.png", "https://image.prepladder.com/content/3dGjaXpAUZdDfRzC2QEE1738567082.png", "https://image.prepladder.com/content/2FxcsmGN0ZfpdSnBdIEw1738567102.png", "https://image.prepladder.com/content/cN9BgtkT21JUJa1X0p9S1738567117.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Waters' View (Occipitomental View)</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chin-up position.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the maxillary sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ng, Qi Xiong &amp; Lim, Xiao &amp; Chong, Jia &amp; Hanafi, Hanida &amp; Lim, Lik Thai. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Plain-skull-X-ray-occipitomental-view-Waters-view-showing-a-black-eyebrow-sign-as_fig2_375528241\" data-tags=\"\" height=\"3541\" src=\"https://image.prepladder.com/content/3EJelKvEOJZWTbqsTy9C1738563707.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pierre’s View</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to Waters' view but with the <strong>mouth open</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bálint Botz\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/normal-waters-view-skull-x-ray\" data-tags=\"\" height=\"1806\" src=\"https://image.prepladder.com/content/3dGjaXpAUZdDfRzC2QEE1738567082.png\" width=\"1999\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caldwell View (Occipitofrontal View)</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chin-down position.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ebrahimnejad, Hamed &amp; Zarch, Seyed &amp; Javadian langaroodi, Adineh. \" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/A-Caldwell-radiograph-showing-opacification-of-frontal-and-ethmoidal-sinuses_fig2_309859475\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/2FxcsmGN0ZfpdSnBdIEw1738567102.png\" width=\"3884\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral View</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral (as the name indicates)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Allows <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of all sinuses (frontal, maxillary, sphenoid, and ethmoidal).</li>\n<li>Helps to understand the <span class=\"customMeta\" data-dictid=\"e80b9923cb1692777195fad978604a\">pneumatization</span> pattern of the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> sinus.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Murphy A, Er A, Bell D,\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Coronal-view-of-Haller-cells-arrows-are-shown-on-both-the-left-and-right-sides_fig1_358616504\" data-tags=\"\" height=\"3121\" src=\"https://image.prepladder.com/content/cN9BgtkT21JUJa1X0p9S1738567117.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yHzFjcdqba5Q5uSg1XgC1746044547.mp3", "video": ""}, {"text": "Identify the structure indicated by the white arrow in the CT scan of the nose and paranasal sinuses shown below", "options": [{"label": "A", "text": "Bulla Ethmoidalis", "correct": false}, {"label": "B", "text": "Haller Cell", "correct": true}, {"label": "C", "text": "Agger Nasi", "correct": false}, {"label": "D", "text": "Concha bullosa", "correct": false}], "correct_answer": "B. Haller Cell", "question_images": ["https://image.prepladder.com/content/KH9tZGYbeqIjMndzKsRm1738567459.png"], "explanation_images": ["https://image.prepladder.com/content/egVPKNtpxDNfr8ZR1KeA1738567544.png", "https://image.prepladder.com/content/Gz1nUeTqq6iqhDUqOBbI1738567586.png", "https://image.prepladder.com/content/GxCzAzZgm0sKOH2Inp4o1738567635.png", "https://image.prepladder.com/content/eDiJZdihwhh5dyBvnTNO1738567673.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CT Scan of Nose and <span class=\"customMeta\" data-dictid=\"e23ca9914316927771948eba43a1e9\">Paranasal</span> Sinuses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Cuts (Anterior to Posterior)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Cut</strong>:</p>\n<ul>\n<li>Structures visible: <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> cavity, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bone structures, <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> septum, and <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> sinus</li>\n</ul>\n<p><strong>Progressing cuts</strong>:</p>\n<ul>\n<li>Nasal bones and bony portion of septum</li>\n<li>Frontal sinus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle Region Cuts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maxillary sinus</li>\n<li>Inferior <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> and septum</li>\n<li>Middle turbinate</li>\n<li><strong>Concha Bullosa </strong><strong>(Option D ruled out)</strong>: Air-filled or <span class=\"customMeta\" data-dictid=\"427fd95b431692777195aa0c3207e4\">pneumatized</span> middle turbinate, which can cause headaches, due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> of surrounding structures.</li>\n<li><strong>Ethmoidal air cells</strong>\n<ul>\n<li><strong>Agger Nasi</strong>: <strong>(Option C ruled out)</strong><strong>:</strong> The anterior-most <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> air cell, visible before the middle turbinate.</li>\n<li><strong>Bulla Ethmoidalis (EB) </strong><strong>(Option A ruled out)</strong>: The largest <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> air cell, visible further posteriorly.</li>\n<li><strong>Haller cell</strong>: Located inferomedially to the orbit, often extending below the middle turbinate, can contribute to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> or <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> issues.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Cuts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenoid sinus</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Concha Bullosa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Agger Nasi </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"MBq \" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Concha_bullosa#/media/File:Conchabullosa.jpg\" data-tags=\"\" height=\"3076\" src=\"https://image.prepladder.com/content/egVPKNtpxDNfr8ZR1KeA1738567544.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Behboudi, Hassan &amp; Heirat, Abtin &amp; Behboudi, Hengameh &amp; Akbari, Maryam &amp; Ramezani, Naghi &amp; Shalchizadeh, Makan &amp; Hajian, Abbas &amp; Nemati, Shadman.\" data-hash=\"\" data-license=\"CC BY NC\" data-source=\"https://www.researchgate.net/figure/Coronal-image-with-arrowhead-showing-Agger-Nasi-air-cell-MS-maxillary-sinus-MT_fig1_351808634\" data-tags=\"\" height=\"2778\" src=\"https://image.prepladder.com/content/Gz1nUeTqq6iqhDUqOBbI1738567586.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bulla Ethmoidalis (EB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Haller Cell</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"A.C, Jyothi &amp; B H, Shrikrishna &amp; Sanjay, G.\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/CORONAL-CT-IMAGE-SHOWING-BILATERAL-LARGE-ETHMOIDAL-BULLAE-EB-COMPROMISING-THE-OUTFLOW_fig1_288945127\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/GxCzAzZgm0sKOH2Inp4o1738567635.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hui, Liuling &amp; Hung, Kuo Feng &amp; Yeung, Andy Wai Kan &amp; Arx, Thomas &amp; Leung, Yiu &amp; Bornstein, Michael. \" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/Coronal-view-of-Haller-cells-arrows-are-shown-on-both-the-left-and-right-sides_fig1_358616504\" data-tags=\"\" height=\"2330\" src=\"https://image.prepladder.com/content/eDiJZdihwhh5dyBvnTNO1738567673.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/R390W78lrZ9TU4AO8J0k1741601177.mp3", "video": ""}, {"text": "A 30-year-old female presents with suspected mastoiditis. The ENT surgeon orders a Law’s view X-ray to assess the mastoid. Which of the following best describes this view?", "options": [{"label": "A", "text": "Lateral oblique view with a 15º tilt", "correct": true}, {"label": "B", "text": "Lateral oblique view with a 30º tilt", "correct": false}, {"label": "C", "text": "AP view with a 30º tilt", "correct": false}, {"label": "D", "text": "AP view with a 15º tilt", "correct": false}], "correct_answer": "A. Lateral oblique view with a 15º tilt", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Vsy2yeWU42iNoSXdNpcI1738567942.png", "https://image.prepladder.com/content/gb21w4LxrqVJ2YBIXY7u1738567863.png", "https://image.prepladder.com/content/8gc3uEZ496oivJJ2KTAa1738567991.png", "https://image.prepladder.com/content/8YLHpowiG9YcPXapeCO81738568060.png", "https://image.prepladder.com/content/YaAQVrYtvTrA2U1p01oh1738568098.png", "https://image.prepladder.com/content/i3X5WksAZJRnZbhxo7Mg1738568144.png", "https://image.prepladder.com/content/KRR0wLngaWQBoKVDlOb21738567889.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray Projection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beam Angle &amp; Positioning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Seen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Applications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Law's View (15° <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> oblique)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ptrump16\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/File:Paranasal_sinuses_radiograph_lateral_projection.jpg\" data-tags=\"\" height=\"1422\" src=\"https://image.prepladder.com/content/Vsy2yeWU42iNoSXdNpcI1738567942.png\" width=\"1999\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sagittal plane of the skull <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the film; <strong>15° <span class=\"customMeta\" data-dictid=\"2c228968d31692777184765d255177\">cephalocaudal</span> </strong>beam angle <strong>(Option A).</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mastoid air cells</li>\n<li>External <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">Acoustic</span> <span class=\"customMeta\" data-dictid=\"6da3f0528c1692777192e9b608d735\">Meatus</span> (EAC)</li>\n<li>Tympanic cavity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Evaluation of <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> air cells</li>\n<li>Mastoiditis</li>\n<li>Mastoid pneumatization</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schuller's View (30° <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> oblique)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1000\" src=\"https://image.prepladder.com/content/gb21w4LxrqVJ2YBIXY7u1738567863.png\" width=\"1000\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to Law's view, but the beam is angled <strong>30° cephalocaudal</strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>EAC superimposed on IAC</li>\n<li>Mastoid air cells</li>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> plate</li>\n<li>Condyle of mandible</li>\n<li>Attic-antral region</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mastoiditis</li>\n<li>Destruction of <span class=\"customMeta\" data-dictid=\"021501f2831692777190ef9ba827fb\">intercellular</span> septa</li>\n<li>Cholesteatoma</li>\n<li>Longitudinal <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">petrous</span> fracture</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stenvers View (Axio-anterior <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> posterior)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Murphy A\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/stenvers-view\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/8gc3uEZ496oivJJ2KTAa1738567991.png\" width=\"4033\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head slightly flexed and rotated 45° opposite to the side under examination; beam angled 12° cephalad</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</li>\n<li>Semicircular canals</li>\n<li>IAC</li>\n<li>Vestibular system</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acoustic neuroma</li>\n<li>Petrositis</li>\n<li>Cholesteatoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Towne's View (30° <span class=\"customMeta\" data-dictid=\"e33029fea3169277720357ed3f0eba\">fronto-occipital</span> axial)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Maradi, Nagaraj &amp; Beesanahalli, Yogeesha &amp; Pawar, Akshay &amp; Jadhav, Tanvi &amp; Deshpande, Shreya\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/ray-Townes-view-showing-elongated-styloid-process_fig3_375898868\" data-tags=\"\" height=\"1999\" src=\"https://image.prepladder.com/content/8YLHpowiG9YcPXapeCO81738568060.png\" width=\"1610\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anteroposterior view with <strong>30° tilt </strong>from above and in front. <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Both <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bones</li>\n<li>Arcuate eminence</li>\n<li>Superior semicircular canal</li>\n<li>Mastoid antrum</li>\n<li>EAC</li>\n<li>Tympanic cavity</li>\n<li>Cochlea</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acoustic neuroma</li>\n<li>Apical petrositis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transorbital View (AP/PA)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Carvalho, Guilherme Machado de &amp; Guimarães, Alexandre &amp; Macedo, Ivan &amp; Onuki, Lucia &amp; Danieli, Fabiana &amp; Pauna, Henrique &amp; Fernandes, Fernando &amp; Paschoal, Jorge &amp; Bianchini, Walter &amp; Castilho, Arthur. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Transorbital-x-ray-image-of-the-patient-at-the-end-of-the-procedure-showing-both_fig8_237070053\" data-tags=\"\" height=\"3116\" src=\"https://image.prepladder.com/content/YaAQVrYtvTrA2U1p01oh1738568098.png\" width=\"4167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orbito-meatal line perpendicular to the film</strong>; <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> beam perpendicular to the film from the <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> area</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>EAC, <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">Mastoid</span> air cells, <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">Mastoid</span> process, Cochlea, IAC, Vestibule, Base of skull, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> rim</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General assessment of <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> and adjacent structures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Submentovertical View (full axial)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Rikhotso, Risimati &amp; Nkonyane, Mbali.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Submento-Vertex-x-ray-showing-left-zygomatic-arch-fracture-arrow_fig1_320949776\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/i3X5WksAZJRnZbhxo7Mg1738568144.png\" width=\"3168\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Head and neck hyperextended, orbito-meatal line <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the film; beam at right angles to the film</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skull base structures, <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">Mastoid</span> process, <span class=\"customMeta\" data-dictid=\"88225eeb1616927771954c1b0bc1e3\">Petrous</span> apex, <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">Tympanic</span> cavity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skull base fractures, <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> involvement, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone fracture</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4I0PcYjFH5FgL1n2DyIO1746044764.mp3", "video": ""}, {"text": "Which of the following statements regarding sialography is false?", "options": [{"label": "A", "text": "Sialography helps diagnose salivary duct issues.", "correct": false}, {"label": "B", "text": "Contrast dye is injected into the salivary duct.", "correct": false}, {"label": "C", "text": "Restricted dye flow indicates potential salivary stones.", "correct": false}, {"label": "D", "text": "Dye is injected into the salivary gland’s blood vessels.", "correct": true}], "correct_answer": "D. Dye is injected into the salivary gland’s blood vessels.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mcgEG9YP9LNPdMmMFaMe1738568276.png"], "explanation": "<p>Correct Answer:D) &lt;span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\"&gt;Dye&lt;/span&gt; is &lt;span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\"&gt;injected&lt;/span&gt; into the salivary gland’s blood vessels.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/O3j97LUqPhMndRnnhMUQ1746044930.mp3", "video": ""}, {"text": "A 6-year-old child presents with severe dysphagia, stridor, and a stiff neck. The physician orders a lateral soft tissue X-ray of the neck as shown. Which of the following is not a feature of this condition on the lateral soft tissue X-ray of the neck?", "options": [{"label": "A", "text": "Widening of the Prevertebral Soft Tissue Shadow", "correct": false}, {"label": "B", "text": "Air Bubbles in the Soft Tissues", "correct": false}, {"label": "C", "text": "Loss of Normal Cervical Lordosis", "correct": false}, {"label": "D", "text": "Narrowing at the subglottic region.", "correct": true}], "correct_answer": "D. Narrowing at the subglottic region.", "question_images": ["https://image.prepladder.com/notes/2Qc94URHs3V3zUUTe4v11746068636.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"c2e956a8441692777197ea505fc27d\">Retropharyngeal</span> Abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic <span class=\"customMeta\" data-dictid=\"c2e956a8441692777197ea505fc27d\">Retropharyngeal</span> <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> (Prevertebral Abscess)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Children: <span class=\"customMeta\" data-dictid=\"9661edc9261692777191c0470c0ecc\">Lymphadenitis</span> of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes of Rouvier</li>\n<li>Adults: <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">Penetrating</span> injury</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>TB spine (Caries spine)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia and difficulty in breathing</li>\n<li>Stridor and <span class=\"customMeta\" data-dictid=\"178653b4ec1692777185f77f5b74d0\">croupy</span> cough</li>\n<li>Torticollis</li>\n<li>Bulge in <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Discomfort in throat</li>\n<li>Dysphagia is not marked</li>\n<li>Posterior pharyngeal wall shows a <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> centrally or on one side of midline</li>\n<li>Neck may show <span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\">tuberculous</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>O/E: </strong></p>\n<p>Bulge on <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral deviation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diffuse midline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Widening of <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">Prevertebral</span> Soft Tissue Shadow: </strong><strong>(Option A)</strong>\n<ul>\n<li>Soft tissue shadow is twice the size of the vertebral body.</li>\n</ul>\n</li>\n<li><strong>Straightening of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> Spine: </strong><strong>(Option C)</strong>\n<ul>\n<li>Loss of normal curvature.</li>\n</ul>\n</li>\n<li><strong>Presence of Air Bubbles: </strong><strong>(Option B)</strong>\n<ul>\n<li>Indicates possible infection or <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-rays are <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> in case of <span class=\"customMeta\" data-dictid=\"382abada90169277718335a73c469a\">caries</span> of <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV antibiotics → <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> &amp; drainage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antitubercular treatment</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/splOu47dTwZ7jIgTlM8d1746045147.mp3", "video": ""}, {"text": "A 45-year-old male presents with a slowly enlarging, painless neck mass near the angle of the mandible. An angiogram of the neck shows the image below: What is this sign known as?", "options": [{"label": "A", "text": "Phelp sign", "correct": false}, {"label": "B", "text": "Dodd sign", "correct": false}, {"label": "C", "text": "Steeple sign", "correct": false}, {"label": "D", "text": "Lyre sign", "correct": true}], "correct_answer": "D. Lyre sign", "question_images": ["https://image.prepladder.com/content/etnouVrxF5lUbUmnQRcL1738570227.png"], "explanation_images": ["https://image.prepladder.com/content/IKWbxU0FrfuqKn0I2EBH1738570216.png", "https://image.prepladder.com/content/ALFAh3OJlGT0TQSL25r91738570293.png", "https://image.prepladder.com/content/66OIhDFcuvyiTYF4qW0x1738570339.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Carotid Body Tumor (CBT)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition &amp; Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A type of <strong>paraganglioma</strong></li>\n<li>CBTs are <strong>benign, slow-growing <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> tumors</strong> derived from <strong>neural <span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\">crest</span> cells.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They arise from the <strong>carotid body</strong>, a small <span class=\"customMeta\" data-dictid=\"64f968d2251692777184286bce1af6\">chemoreceptor</span> located at the <span class=\"customMeta\" data-dictid=\"6c076ff67d1692777183dff2a71da1\">bifurcation</span> of the common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CBTs are the <strong>most common paraganglioma</strong> of the head and neck.</li>\n<li>Familial CBT is associated with mutations in the <strong>SDH gene</strong> (Succinate <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">Dehydrogenase</span> Complex Gene - SDHB, SDHD).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painless, slow-growing neck mass</li>\n<li><strong>Symptoms due to compression</strong> of nearby structures, such as dysphagia, hoarseness, or a <span class=\"customMeta\" data-dictid=\"6489bd931b1692777183431530dacf\">bruit</span> on auscultation.</li>\n<li><strong>Catecholamine-secreting tumors </strong>can cause <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms like hypertension, palpitations, and sweating.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT Angiogram/ DSA:</strong> <strong>Lyre sign </strong><strong>(Option A)</strong> - splaying of the internal and external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> arteries.</li>\n<li><strong>MRI:</strong> Salt and pepper appearance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical resection</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yWC1EnXedXi392YguufA1746045330.mp3", "video": ""}, {"text": "A 7-year-old male presents to the clinic with painful neck stiffness and torticollis four days after undergoing adenoidectomy for chronic adenoiditis. Physical examination reveals restricted neck movement in all directions and a “cock-robin” position of the head. Neurological examination is normal. Which of the following best describes the underlying condition?", "options": [{"label": "A", "text": "Traumatic atlantoaxial subluxation following cervical injury", "correct": false}, {"label": "B", "text": "Non-traumatic atlantoaxial subluxation secondary to infection or surgery", "correct": true}, {"label": "C", "text": "Atlanto-occipital dislocation caused by a congenital cervical spine anomaly", "correct": false}, {"label": "D", "text": "Acute cervical disc herniation causing torticollis", "correct": false}], "correct_answer": "B. Non-traumatic atlantoaxial subluxation secondary to infection or surgery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RcknxWt4iLENx38lxhes1738570450.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Grisel's Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nontraumatic <span class=\"customMeta\" data-dictid=\"e4237039b716927771828007d91697\">atlantoaxial</span> <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> </strong><strong>(Option B),</strong> often secondary to upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <strong>infections</strong> or <strong>post-surgery</strong> in the head and neck region (e.g., adenoidectomy).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loosening of the <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> and <span class=\"customMeta\" data-dictid=\"465de815bb169277718175b199ae39\">alar</span> ligaments due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> in the <span class=\"customMeta\" data-dictid=\"e4237039b716927771828007d91697\">atlantoaxial</span> joint.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Painful torticollis</li>\n<li>neck stiffness</li>\n<li>\"Cock-robin\" head position.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-ray or CT shows rotational <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> of C1-C2.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early intervention with <strong>bed rest</strong></li>\n<li><strong>Cervical immobilization</strong></li>\n<li>Antibiotics</li>\n<li>Anti-inflammatory agents to prevent neurological sequelae.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications of adenoidectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hemorrhage (most common)</strong>\n<ul>\n<li><strong>Primary hemorrhage: </strong>Occurs intraoperatively from the <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> site.</li>\n<li><strong>Reactionary <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> (within 24 hours of the surgery): </strong>occurs due to the displaced <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> or slippage of ligature.</li>\n<li><strong>Secondary hemorrhage(24 hours upto 14 days of surgery): </strong>Occurs due to infection.</li>\n</ul>\n</li>\n<li>Injury to pharyngeal <span class=\"customMeta\" data-dictid=\"76c542bf481692777193e617467333\">musculature</span> and <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> vertebrae.</li>\n<li>Injury to <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube opening.</li>\n<li><strong>Grisel's syndrome</strong></li>\n<li><strong>Velopharyngeal insufficiency</strong></li>\n<li>Nasopharyngeal stenosis</li>\n<li><strong>Recurrence</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3kNzAzRgowDzWJvgoX1c1746640757.mp3", "video": ""}, {"text": "A 40-year-old male has a deviated septum with a significant dislocation at the caudal end. The surgeon prefers a unilateral approach, avoiding a full-thickness incision. Which incision is most appropriate in this case?", "options": [{"label": "A", "text": "Killian’s incision", "correct": false}, {"label": "B", "text": "Hemitransfixion incision", "correct": true}, {"label": "C", "text": "Transfixion incision", "correct": false}, {"label": "D", "text": "Horizontal incision on the spur", "correct": false}], "correct_answer": "B. Hemitransfixion incision", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CXNgcXpj4bNCPGW4PLT81738570602.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types of septal incisions for septoplasty</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Killian’s </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> mucosa, <span class=\"customMeta\" data-dictid=\"3b78d9438716927771841c88afb16c\">cephalic</span> to the <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> end of the septum</li>\n<li>Slightly curvilinear incision, 2-3 mm above the <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> end of septal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> on the <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> side.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transfixion </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Through and through incision</strong>, close to but <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> to <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> end of the septum.</li>\n<li>Used in<strong> <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> septal dislocation</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemitransfixion </strong></p>\n<p><strong>(Freer’s incision)</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Same as the <span class=\"customMeta\" data-dictid=\"f92d3c9a021692777200efdeb005e1\">transfixion</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> but <strong>on one side</strong>, not through and through.</li>\n<li>Used in<strong> <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> septal dislocation</strong></li>\n<li><strong>Septocolumellar incision</strong> between <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> end of septal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and columella.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Horizontal on the <span class=\"customMeta\" data-dictid=\"77dc1bdd7416927771991cd9877b25\">Spur</span> </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> spurectomy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/A5u7peviUjnpvxAZifaj1746045612.mp3", "video": ""}, {"text": "A 45-year-old male presents with severe nasal obstruction, headaches, and a history of multiple nasal surgeries for chronic sinusitis and nasal polyps. On endoscopic examination, there is extensive polyposis with distortion of normal anatomical landmarks. The surgeon decides to use a posterior-to-anterior surgical approach for better access and disease clearance. Which surgical technique is most appropriate in this case?", "options": [{"label": "A", "text": "Stammberger’s technique", "correct": false}, {"label": "B", "text": "Wigand’s technique", "correct": true}, {"label": "C", "text": "Messerklinger’s approach", "correct": false}, {"label": "D", "text": "Caldwell-Luc procedure", "correct": false}], "correct_answer": "B. Wigand’s technique", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cccaKFijAdCXD0dMxxBm1746045782.mp3", "video": ""}, {"text": "Which of the following statements, regarding the different types of mastoidectomy, is CORRECT?", "options": [{"label": "A", "text": "Canal Wall Down mastoidectomy preserves the integrity of the postero-superior canal wall", "correct": false}, {"label": "B", "text": "Schwartze’s mastoidectomy is a type of Canal Wall Down mastoidectomy", "correct": false}, {"label": "C", "text": "Modified radical mastoidectomy involves the removal of the postero-superior canal wall", "correct": true}, {"label": "D", "text": "In Canal Wall Up mastoidectomy, the mastoid cavity remains open.", "correct": false}], "correct_answer": "C. Modified radical mastoidectomy involves the removal of the postero-superior canal wall", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CANAL WALL UP (CWU)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CANAL WALL DOWN (CWD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple/ cortical/Schwartze's <span class=\"customMeta\" data-dictid=\"12d9c7a4041692777191aa892d206f\">Mastoidectomy</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Modified Radical Mastoidectomy/ Bondy's Procedure <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Classic Intact <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">Canal</span> Wall, Combined</p>\n<p>Approach <span class=\"customMeta\" data-dictid=\"48d47330b01692777201c15f8dd6b5\">Tympanoplasty</span> (CAT)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radical Mastoidectomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atticotomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atticoantrotomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/yrC8B3klL4RdoedAp4bk1746045953.mp3", "video": ""}, {"text": "A 28-year-old woman presents with a history of chronic otitis media. Examination shows a dry tympanic membrane perforation without active infection. She has a 30 dB hearing loss. Which of the following procedures is most appropriate to improve her hearing?", "options": [{"label": "A", "text": "Myringotomy with grommet insertion", "correct": false}, {"label": "B", "text": "Myringoplasty using a temporalis fascia graft", "correct": true}, {"label": "C", "text": "Tympanostomy tube placement", "correct": false}, {"label": "D", "text": "Antibiotic therapy with corticosteroids", "correct": false}], "correct_answer": "B. Myringoplasty using a temporalis fascia graft", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3e21tQuYnqTHKUmicoaw1738570692.png", "https://image.prepladder.com/content/HMnUl1UuYRjDJDrEAsGv1738570710.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Additional Information</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myringoplasty</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Close perforation, improve hearing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Underlay/overlay <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> placement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myringotomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relieve pressure from fluid buildup</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often combined with <span class=\"customMeta\" data-dictid=\"efcdc8d2f71692777188341ac61941\">grommet</span> insertion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grommet insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Drain fluid (Otitis media with effusion)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Synonymous with <span class=\"customMeta\" data-dictid=\"c4dbd6ca44169277720159670bf547\">tympanostomy</span> tube</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/VLpbY0rS6kYOtD42JPVB1746044391.mp3", "video": ""}, {"text": "A 30-year-old patient with a chronic middle ear infection presents with a perforated tympanic membrane and erosion of the malleus. Based on Wullstein's classification of tympanoplasty, which type of tympanoplasty would be most appropriate for this patient?", "options": [{"label": "A", "text": "Type I tympanoplasty", "correct": false}, {"label": "B", "text": "Type II tympanoplasty", "correct": true}, {"label": "C", "text": "Type III tympanoplasty", "correct": false}, {"label": "D", "text": "Type IV tympanoplasty", "correct": false}], "correct_answer": "B. Type II tympanoplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MwDdBhs8HEgpuUyguQTN1738570826.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type I (Myringoplasty)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repair of a <strong>perforated <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane</strong> with a graft. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed on the <strong>incus or malleus</strong> <span class=\"customMeta\" data-dictid=\"bead1cecfa16927771979940742ada\">remnant</span> due to <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> erosion. <strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed on the <strong>stapes head</strong> when <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> and <span class=\"customMeta\" data-dictid=\"457c9fd53e1692777190857c3e636b\">incus</span> are absent. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Graft placed between the <strong>oval and round windows</strong> when only the <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> remains; <span class=\"customMeta\" data-dictid=\"fe64013c57169277718385df27ef40\">cavum</span> minor created. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fenestration</strong> in the <strong>horizontal semicircular canal,</strong> creating a new window with a graft. Performed when <span class=\"customMeta\" data-dictid=\"fc779771f31692777199ead13901c3\">stapes</span> <span class=\"customMeta\" data-dictid=\"4c2b982c911692777203578c7b9a9c\">footplate</span> is fixed.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/u9M97TQz5hVkHwwGdKyP1746044121.mp3", "video": ""}, {"text": "Identify the given instrument.", "options": [{"label": "A", "text": "Mollison’s Mastoid Retractor", "correct": false}, {"label": "B", "text": "Jansen’s Mastoid Retractor", "correct": true}, {"label": "C", "text": "Lempert’s endaural retractor", "correct": false}, {"label": "D", "text": "Lempert’s endaural speculum", "correct": false}], "correct_answer": "B. Jansen’s Mastoid Retractor", "question_images": ["https://image.prepladder.com/content/YS3PzoQIGtTm2VIYCruv1738571226.png"], "explanation_images": ["https://image.prepladder.com/content/j8qawOe6DIlkS4qD6APo1738571280.png", "https://image.prepladder.com/content/GE0CbmtNzhDw8XVdGgeB1738571372.png", "https://image.prepladder.com/content/ZMBhC3t0A6bdDb1pB4Oj1738571397.png", "https://image.prepladder.com/content/fGBCURJy7wFJUBh1pjIK1738571422.png", "https://image.prepladder.com/content/dJc6iZBrA4LkKcXOBKGJ1738571441.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/848024.mp3", "video": ""}, {"text": "Identify the instrument used to reduce fractures of nasal septum.", "options": [{"label": "A", "text": "Luc's Forceps", "correct": false}, {"label": "B", "text": "Ballenger Swivel Knives", "correct": false}, {"label": "C", "text": "Asch's Septum Forceps", "correct": true}, {"label": "D", "text": "Walsham’s Forceps", "correct": false}], "correct_answer": "C. Asch's Septum Forceps", "question_images": ["https://image.prepladder.com/content/fWpEgc1KD4GLznULQz2L1738571669.png"], "explanation_images": ["https://image.prepladder.com/content/J2vkVcd8UKtc2NtnM6sQ1738571679.png", "https://image.prepladder.com/content/GboNwPO4bPTYTjRp3hxp1738571759.png", "https://image.prepladder.com/content/xJ2AxAuLgaQmEQVx3YyO1738571719.png", "https://image.prepladder.com/content/EHOhHx4qXbwuKVoQ3vgT1738571733.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/848025.mp3", "video": ""}, {"text": "Which of the following is not a characteristic of the Saint-Clair Thompson Adenoidectomy Curette?", "options": [{"label": "A", "text": "It is held like a dagger in the dominant hand", "correct": false}, {"label": "B", "text": "It is used with limited direct visualization, often blind", "correct": false}, {"label": "C", "text": "It is used without the cage for larger pieces of adenoid tissue", "correct": true}, {"label": "D", "text": "The curette is inserted under the soft palate to remove tissue using an inferior to superior motion.", "correct": false}], "correct_answer": "C. It is used without the cage for larger pieces of adenoid tissue", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/avdabhFuxVv1MheolwEv1738571834.png", "https://image.prepladder.com/content/1hRmiz7bHVGKAkUfuhS21738571854.png", "https://image.prepladder.com/content/HYJLHfFt27FnWObhZunT1738571867.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/848026.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 7 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Match the following? a. Trisomy 13 1. Huntington's disease b. Trisomy 18 2. Patau syndrome c. Trinucleotide repeat sequence 3. Sickle disease d. Hb point mutation of glutamate to valine 4. Edward syndrome", "options": [{"label": "A", "text": "a-2, b-4, c-1, d-3", "correct": true}, {"label": "B", "text": "b-1, a-3, d-2, c-4", "correct": false}, {"label": "C", "text": "a-2, b-1, c-4, d-3", "correct": false}, {"label": "D", "text": "a-4, b-1, c-3, d-2", "correct": false}], "correct_answer": "A. a-2, b-4, c-1, d-3", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - a-2, b-4, c-1, d-3</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chromosomal anomaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trisomy 13</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Patau syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Short life expectancy</li>\n<li>Cleft lip and palate</li>\n<li>Polydactyly</li>\n<li>Small head</li>\n<li>Frequent <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trisomy 18</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Edward syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Early demise</li>\n<li>Characteristic skull and facies</li>\n<li>Frequent heart, kidney, and other organ anomalies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trinucleotide repeat sequence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Huntington's disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Motor disturbances</li>\n<li>Behavioural and psychiatric symptoms</li>\n<li>Cognitive decline</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hb point <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> of <span class=\"customMeta\" data-dictid=\"ada5fcf7e416927771886ff24152ff\">glutamate</span> to valine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sickle disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anemia</li>\n<li>Jaundice</li>\n<li>Dactylitis</li>\n<li>Sickle cell crisis</li>\n<li>Fatigue</li>\n<li>Fever</li>\n<li>Chest pain</li>\n<li>Shortness of breath</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How much sodium deficit needs to be corrected in a 40 kg female with a serum sodium level of 120 mEq/L to achieve a desired sodium concentration of 140 mEq/L?", "options": [{"label": "A", "text": "400 mEq", "correct": true}, {"label": "B", "text": "300 mEq", "correct": false}, {"label": "C", "text": "200 mEq", "correct": false}, {"label": "D", "text": "100 mEq", "correct": false}], "correct_answer": "A. 400 mEq", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 400 mEq\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the medication review of an elderly male patient with a history of COPD, hypertension, and diabetes, what criteria should the physician consider?", "options": [{"label": "A", "text": "Duke’s criteria", "correct": false}, {"label": "B", "text": "Light criteria", "correct": false}, {"label": "C", "text": "Beer’s criteria", "correct": true}, {"label": "D", "text": "Jones criteria", "correct": false}], "correct_answer": "C. Beer’s criteria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Beer’\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What vitamin deficiency is responsible for the following symptoms in a patient: tingling sensation in the hands and feet, generalized weakness, easy fatigability, pallor, and ataxia?", "options": [{"label": "A", "text": "Vitamin B1", "correct": false}, {"label": "B", "text": "Vitamin B12", "correct": true}, {"label": "C", "text": "Vitamin B2", "correct": false}, {"label": "D", "text": "Vitamin B3", "correct": false}], "correct_answer": "B. Vitamin B12", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">Vitamin</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Deficiency Disease</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Symptoms</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B1 (Thiamine)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Beriberi</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Peripheral neuropathy, muscle wasting, heart failure</span></span></span></span></p>\n<p><span><span><span><span style=\"color:black\">Wernicke-Korsakoff’s syndrome</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B2 (Riboflavin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Ariboflavinosis</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Glossitis, cheilosis, skin rash, <span class=\"customMeta\" data-dictid=\"9038419f6f169277719188195b72b5\">magenta</span> color tongue, <span class=\"customMeta\" data-dictid=\"5d5241c3cf1692777198a1ba71f8d4\">seborrheic</span> dermatitis</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B3 (Niacin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Pellagra</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, diarrhea, dementia</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B5 (Pantothenic acid)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Paresthesia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Numbness, tingling, burning sensation in hands and feet(burning foot syndrome)</span></span></span></span></p>\n<p><span><span><span><span style=\"color:black\">Dermatitis, enteritis, <span class=\"customMeta\" data-dictid=\"5cac5dbe851692777181a2373219b0\">alopecia</span> , ataxia</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B6 (Pyridoxine)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Microcytic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> ,convulsions, depression</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B7 (Biotin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, enteritis</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Dermatitis, , atrophic glossitis, alopecia, <span class=\"customMeta\" data-dictid=\"14d1b66f821692777194e77a2edc9f\">paresthesia</span> , muscle pain, anorexia, hallucinations</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B9 (Folate)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Megaloblastic anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Megaloblastic <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> ,neuropathy, <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects, atrophic glossitis</span></span></span></span></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><span><span><span><span style=\"color:black\">B12 (Cobalamin)</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Pernicious anemia</span></span></span></span></p>\n</td>\n<td>\n<p><span><span><span><span style=\"color:black\">Peripheral neuropathy, weakness, fatigue, pallor- dementia, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord degeneration, homocysteinemia</span></span></span></span></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cat scratch disease is caused by?", "options": [{"label": "A", "text": "Bartonella henselae", "correct": true}, {"label": "B", "text": "b.Bartonella quintana", "correct": false}, {"label": "C", "text": "c.Bartonella bacilliformis", "correct": false}, {"label": "D", "text": "d.Borrelia burgdorferi", "correct": false}], "correct_answer": "A. Bartonella henselae", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man brings his father who became unconscious while working in a field in the host sun at 42 degrees Celsius in May. One examination, there were no physical signs of dehydration. His serum electrolyte values were normal. The physician found that the body temperature was 106 F. Which of the following symptoms is least likely to be seen in this patient?", "options": [{"label": "A", "text": "Nausea", "correct": false}, {"label": "B", "text": "Hypotension", "correct": false}, {"label": "C", "text": "Sweating", "correct": true}, {"label": "D", "text": "Headache", "correct": false}], "correct_answer": "C. Sweating", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a tall male with a lack of pubic and axillary hair, underdeveloped genitalia, elevated levels of LH and FSH, and a karyotype of XXY?", "options": [{"label": "A", "text": "a.Vanishing testis syndrome", "correct": false}, {"label": "B", "text": "b.Klinefelter’s syndrome", "correct": true}, {"label": "C", "text": "c.Noonan syndrome", "correct": false}, {"label": "D", "text": "d.Adrenal hyperplasia", "correct": false}], "correct_answer": "B. b.Klinefelter’s syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 17 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 18 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following best describes the drainage pathway of the sinus that is marked with an arrow in the image below?", "options": [{"label": "A", "text": "Sphenoethmoidal recess", "correct": false}, {"label": "B", "text": "Superior meatus", "correct": false}, {"label": "C", "text": "Middle meatus", "correct": true}, {"label": "D", "text": "Ethmoid bulla", "correct": false}], "correct_answer": "C. Middle meatus", "question_images": ["https://image.prepladder.com/content/kgo2W1MphxftRxyxzAeZ1738618004.png"], "explanation_images": ["https://image.prepladder.com/content/N5etTF8hkSQqn7SW1z8b1738619059.png", "https://image.prepladder.com/content/c6Zaeis8Kt0ETOzaezi51738618090.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:50%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sinus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Full Development</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maxillary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present at birth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-18 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ethmoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present at birth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-14 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-5 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-15 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-4 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18-20 years</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2irRgA2tFw0SkJimG0fg1745316267.mp3", "video": ""}, {"text": "A 45-year-old patient complains of difficulty breathing through their nose. He also reports complaints of smell perception. The otolaryngologist decides to perform both the University of Pennsylvania Smell Identification Test (UPSIT) and rhinomanometry. Which of the following statements regarding these tests is INCORRECT?", "options": [{"label": "A", "text": "The UPSIT helps to understand if the patient's ability to perceive smell is good or bad.", "correct": false}, {"label": "B", "text": "Rhinomanometry is a subjective function test to assess nasal airflow.", "correct": true}, {"label": "C", "text": "In the UPSIT, the patient is given scratch cards of odorous stimuli and asked to write down the smell.", "correct": false}, {"label": "D", "text": "Rhinomanometry results can be used to check for improvement after nasal surgery.", "correct": false}], "correct_answer": "B. Rhinomanometry is a subjective function test to assess nasal airflow.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kePdRYbe090Y6gJkPV5I1745263101.mp3", "video": ""}, {"text": "Which of the following statements about the airflow dynamics during respiration through the nose is INCORRECT?", "options": [{"label": "A", "text": "Mouth breathing is not present in newborns", "correct": false}, {"label": "B", "text": "Very little air passes through olfactory region of nose", "correct": false}, {"label": "C", "text": "Maximum airflow during quiet respiration occurs through inferior turbinate", "correct": true}, {"label": "D", "text": "Friction during expiration causes the air to form eddies at the nasal valve , ventilating the sinuses.", "correct": false}], "correct_answer": "C. Maximum airflow during quiet respiration occurs through inferior turbinate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GBFtwR7Xol2AHx6MdhZg1745262861.mp3", "video": ""}, {"text": "A junior resident is studying the anatomy of the medial wall of the orbit. Which of the following statements about this structure is INCORRECT?", "options": [{"label": "A", "text": "The medial walls of both orbits run parallel to each other and form the lateral walls of ethmoid air cell.", "correct": false}, {"label": "B", "text": "The medial wall is formed by parts of the sphenoid, ethmoid, lacrimal, and maxillary bones.", "correct": false}, {"label": "C", "text": "The anterior and posterior ethmoidal foramina are located at the junction of the roof and the lateral wall of the orbit.", "correct": true}, {"label": "D", "text": "The optic canal is situated at the posterior junction of the medial wall and the roof of the orbit.", "correct": false}], "correct_answer": "C. The anterior and posterior ethmoidal foramina are located at the junction of the roof and the lateral wall of the orbit.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BiOQJht86kefqRruLSzH1738618858.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> Wall of Orbit</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formed by parts of the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> bone, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> surface of the <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> bone, <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> bone, and <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> process of the maxilla.</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"258\" src=\"https://image.prepladder.com/content/BiOQJht86kefqRruLSzH1738618858.png\" width=\"500\"/></p>\n<p><strong> Fig: Composition of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> Wall of Orbit</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orientation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall; forms <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ethmoidal Air Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Air-filled spaces in the <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> bone portion of the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Foramina</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">Ethmoidal</span> Foramen</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">Ethmoidal</span> Foramen</li>\n<li>Optic canal</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8UBNlabExM9Dwu519W391746643829.mp3", "video": ""}, {"text": "Which of the following statements about the venous drainage of the nose is FALSE?", "options": [{"label": "A", "text": "The venous networks parallel the arterial supply in their distribution.", "correct": true}, {"label": "B", "text": "The fronto-median area drains to the facial vein, while the orbito-palpebral area drains to the ophthalmic vein.", "correct": false}, {"label": "C", "text": "The facial vein originates as the angular vein, which is formed by the confluence of the supratrochlear and supraorbital veins.", "correct": false}, {"label": "D", "text": "Infections in the upper lip and nose can potentially spread to the cavernous sinus due to a valveless venous connection.", "correct": false}], "correct_answer": "A. The venous networks parallel the arterial supply in their distribution.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SKEazH0ap0BwnHEHWeR41738618729.png", "https://image.prepladder.com/content/YiW6AJs1C0aVBx2ziXsb1738618767.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/otOcwjNSkl26Mt1fNWHs1745262366.mp3", "video": ""}, {"text": "Which of the following statements about the lining membrane of the internal nose is INCORRECT?", "options": [{"label": "A", "text": "The vestibule is lined by skin containing hair, hair follicles, and sebaceous glands.", "correct": false}, {"label": "B", "text": "The olfactory region covers the lower two-thirds of the nasal cavity.", "correct": true}, {"label": "C", "text": "The respiratory region's mucous membrane is thickest over nasal conchae.", "correct": false}, {"label": "D", "text": "The olfactory region's membrane is paler in color compared to other regions.", "correct": false}], "correct_answer": "B. The olfactory region covers the lower two-thirds of the nasal cavity.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1ko9ezNxcQ249FIeubib1738618624.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Feature</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vestibule </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Entrance of the nose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Skin containing hair, hair follicles, and <span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\">sebaceous</span> glands</li>\n<li><strong>Epithelium- </strong>Stratified <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> epithelium</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acts as initial filter for air entering the nose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Olfactory Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper one-third of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall, corresponding part of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, and roof of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Olfactory epithelium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Specialized for detecting odors, <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> is paler in color <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower two-thirds of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pseudostratified <span class=\"customMeta\" data-dictid=\"633c742e4116927771845f77370d44\">ciliated</span> <span class=\"customMeta\" data-dictid=\"8ff554096316927771851cc310435e\">columnar epithelium</span> with goblet cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> (thickest over <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> conchae) <strong>(Option C)</strong>, highly vascular, contains <span class=\"customMeta\" data-dictid=\"5cc2a2112e16927771874c5d97065a\">erectile</span> tissue</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Vi7myNjzYt3R855SnzDh1745262033.mp3", "video": ""}, {"text": "Which type of sphenoid sinus pneumatization is contraindicated in endoscopic transsphenoidal surgery?", "options": [{"label": "A", "text": "Sellar", "correct": false}, {"label": "B", "text": "Presellar", "correct": false}, {"label": "C", "text": "Conchal", "correct": true}, {"label": "D", "text": "post sellar", "correct": false}], "correct_answer": "C. Conchal", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4PVajVg6jrukRWwDzaVi1745475153.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fr6777MFoEGEcFKiWKfL1745261493.mp3", "video": ""}, {"text": "A 50-year-old male complains of deep-seated headaches and visual disturbances. Imaging reveals a sphenoid sinus mucocele compressing adjacent structures. Which of the following is most likely to be compressed by this mucocele?", "options": [{"label": "A", "text": "Optic nerve", "correct": true}, {"label": "B", "text": "Mandibular nerve", "correct": false}, {"label": "C", "text": "Middle meningeal artery", "correct": false}, {"label": "D", "text": "Superior sagittal sinus", "correct": false}], "correct_answer": "A. Optic nerve", "question_images": ["https://image.prepladder.com/content/FmTTtpvE6u7gmbIFf0HK1738618319.png"], "explanation_images": ["https://image.prepladder.com/content/KYs9pX7Uc5YX2fIVboxm1738618381.png", "https://image.prepladder.com/content/a9kGjTyJDIgsUilYMLEN1738618435.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CjQwYYXVvxdICQudIpV61745260685.mp3", "video": ""}, {"text": "Which of the following is NOT true regarding the ethmoid air cells?", "options": [{"label": "A", "text": "The anterior ethmoid air cells drain into the middle meatus.", "correct": false}, {"label": "B", "text": "They are the last of the paranasal sinuses to fully develop.", "correct": true}, {"label": "C", "text": "They are closely related to the orbit.", "correct": false}, {"label": "D", "text": "The posterior ethmoid air cells drain into the superior meatus.", "correct": false}], "correct_answer": "B. They are the last of the paranasal sinuses to fully develop.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PYZGIl6w2YQSFmABk3hC1738618188.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Full Development</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maxillary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present at birth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-18 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ethmoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present at birth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-14 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenoid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-5 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-15 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-4 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18-20 years</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZHtm7ijtbOjT7FtYgWzX1745260523.mp3", "video": ""}, {"text": "All the following are paired cartilage forming the external nose anatomy except:", "options": [{"label": "A", "text": "Septal cartilage", "correct": true}, {"label": "B", "text": "Upper lateral cartilage", "correct": false}, {"label": "C", "text": "Lower lateral cartilage", "correct": false}, {"label": "D", "text": "Sesamoid cartilage", "correct": false}], "correct_answer": "A. Septal cartilage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qhXtCUVKrJNcwTzZxb921738617198.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0fndv3bd9t9Ek0gg85L41745253035.mp3", "video": ""}, {"text": "Which structure lies posterior to the posterior wall of the maxillary sinus?", "options": [{"label": "A", "text": "Nasolacrimal duct", "correct": false}, {"label": "B", "text": "Optic nerve", "correct": false}, {"label": "C", "text": "Pterygopalatine fossa", "correct": true}, {"label": "D", "text": "Inferior rectus muscle", "correct": false}], "correct_answer": "C. Pterygopalatine fossa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PdSYP3CFt8rWJwnFJDPH1738617899.png", "https://image.prepladder.com/content/UaK5bDMXvqzqESEWIDA21738617931.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tM83okOj8mLra9wI0GD81745260130.mp3", "video": ""}, {"text": "Which of the following is NOT a part of the middle meatus of the nose?", "options": [{"label": "A", "text": "Uncinate process", "correct": false}, {"label": "B", "text": "Bulla ethmoidalisOstiomeatal complex", "correct": false}, {"label": "C", "text": "Ostiomeatal complex", "correct": false}, {"label": "D", "text": "Nasolacrimal duct opening", "correct": true}], "correct_answer": "D. Nasolacrimal duct opening", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/z5kZTeeJQx9r6QL4neJb1738617783.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/whvE0WQ9jVhaA9pOhqGN1745259646.mp3", "video": ""}, {"text": "Match the following: 1. Middle Meatus a) Sphenoid sinus 2. Superior Meatus b) Frontal sinus 3. Sphenoethmoidal Recess c) Posterior Ethmoid sinus", "options": [{"label": "A", "text": "1-d, 2-b, 3-c", "correct": false}, {"label": "B", "text": "1-c, 2-a, 3-d", "correct": false}, {"label": "C", "text": "1-d, 2-a, 3-c", "correct": false}, {"label": "D", "text": "1-b, 2-c, 3-a", "correct": true}], "correct_answer": "D. 1-b, 2-c, 3-a", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Pf6uQZQ6Cqjq4QzVfyLJ1738617709.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MEATUS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DRAINAGE OF SINUS</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle Meatus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ostiomeatal Unit or Complex of frontal, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> ethmoidal, and maxillary sinuses drain.</li>\n<li>Common <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> group of sinuses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior Meatus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">Ethmoid</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> drains.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sphenoethmoidal Recess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenoid <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> drains.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior Meatus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"7ae0be0842169277719364f6d75e91\">nasolacrimal</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> opens here.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Av6IqqY1eaxPHyq6vY9L1745259367.mp3", "video": ""}, {"text": "Which of the following statements about the lateral nasal wall is correct?", "options": [{"label": "A", "text": "The lateral nasal wall has turbinates: inferior, middle, superior, and supreme.", "correct": true}, {"label": "B", "text": "Spaces below the turbinates are called sinuses.", "correct": false}, {"label": "C", "text": "The turbinates include inferior, middle, superior, and lateral.", "correct": false}, {"label": "D", "text": "Spaces below the turbinates are meatuses: superior, middle, and supreme.", "correct": false}], "correct_answer": "A. The lateral nasal wall has turbinates: inferior, middle, superior, and supreme.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/D2Jpud9UuQ4ESk6y3FWB1738617646.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aaM0eJEAadaDV7BOqXNe1745259009.mp3", "video": ""}, {"text": "Which of the following statements regarding the medial wall of the nose is FALSE?", "options": [{"label": "A", "text": "The anterior ethmoidal artery is a branch of the internal carotid system.", "correct": false}, {"label": "B", "text": "The sphenopalatine artery is a branch of the maxillary artery from the external carotid system.", "correct": false}, {"label": "C", "text": "Kiesselbach’s plexus is formed by the anastomosis of the anterior &amp;amp; posterior ethmoidal, sphenopalatine, and infraorbital arteries.", "correct": true}, {"label": "D", "text": "The columellar septum is formed by the medial crura of the alar cartilages.", "correct": false}], "correct_answer": "C. Kiesselbach’s plexus is formed by the anastomosis of the anterior &amp; posterior ethmoidal, sphenopalatine, and infraorbital arteries.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DRhNzt7ahXhaGgerHqb91738618961.png", "https://image.prepladder.com/content/biRcCjg1h3gLzPlF0mrC1738617558.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medial wall of nose (Nasal septum)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Components of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> septum:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Columellar Septum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Formed by the <span class=\"customMeta\" data-dictid=\"e03b2f95ab1692777184437bf8f3c5\">columella</span> containing <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"c0f500688016927771854a06750f2e\">crura</span> of <span class=\"customMeta\" data-dictid=\"465de815bb169277718175b199ae39\">alar</span> cartilages. <strong>(Option D)</strong></li>\n<li>United by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue and covered by skin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Membranous Septum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Composed of a double layer of skin without bony or <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> support.</li>\n<li>Located between the <span class=\"customMeta\" data-dictid=\"e03b2f95ab1692777184437bf8f3c5\">columella</span> and the <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> border of the septal cartilage.</li>\n<li>Freely movable from side to side.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Septum Proper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Consists of <span class=\"customMeta\" data-dictid=\"aa1d5772fa1692777194384ce9d1d6\">osteocartilaginous</span> framework covered with <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membrane.</li>\n<li>Principal parts:\n\t\t\t\t<ul>\n<li>Perpendicular plate of <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> bone.</li>\n<li>Vomer bone.</li>\n<li>Septal (quadrilateral) <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> between the <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> and vomer.</li>\n</ul>\n</li>\n<li>Minor contributions from surrounding bones: <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bones, <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> bone, sphenoid, <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> bones, maxilla, and <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> spine.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/DRhNzt7ahXhaGgerHqb91738618961.png\" width=\"500\"/></p>\n<p style=\"text-align: center;\"><strong>Fig: <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">Septum</span> Proper</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasal <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">Septum</span> Blood Supply:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">Ethmoidal</span> Artery: <strong>(Option A)</strong>\n<ul>\n<li>A branch of the <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> artery.</li>\n</ul>\n</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">Ethmoidal</span> Artery:\n\t\t\t\t<ul>\n<li>A branch of the <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> artery.</li>\n</ul>\n</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>External <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Sphenopalatine <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (SPA): <strong>(Option B)</strong>\n<ul>\n<li>A branch of the maxillary artery.</li>\n<li>Gives off <span class=\"customMeta\" data-dictid=\"e2b45850db16927771930b8139cc3f\">nasopalatine</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> branches.</li>\n</ul>\n</li>\n<li>Septal Branch of Greater <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">Palatine</span> Artery:\n\t\t\t\t<ul>\n<li>A branch of the maxillary artery.</li>\n</ul>\n</li>\n<li>Septal Branch of Superior <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">Labial</span> Artery:\n\t\t\t\t<ul>\n<li>A branch of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> artery.</li>\n</ul>\n</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Little’s Area (Kiesselbach’s Plexus)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Located at Anterior-inferior part of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, just above the vestibule.</li>\n<li>Formed by the <span class=\"customMeta\" data-dictid=\"7fb96d08421692777181e532c3c653\">anastomosis</span> of: <strong>(Option C)</strong>\n<ul>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> artery</li>\n<li>Sphenopalatine artery</li>\n<li>Greater <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery</li>\n<li>Septal branch of the superior <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">labial</span> artery</li>\n</ul>\n</li>\n<li>Commonest site for nosebleeds (epistaxis).</li>\n<li>Most common cause: Trauma/Nose Picking</li>\n<li>Most common cause in adults: Hypertension</li>\n<li>Site where \"bleeding polypus\" (haemangioma) of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> can originate.</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> that is present at the <span class=\"customMeta\" data-dictid=\"41e94373611692777196d1b5f8d703\">posteroinferior</span> portion of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> is known as <strong>Woodruff's plexus</strong>.</li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/biRcCjg1h3gLzPlF0mrC1738617558.png\" width=\"500\"/></p>\n<p style=\"text-align: center;\"><strong>Fig: Blood supply of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Septum</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/GVszILYGGP9vj2Sf8dbz1745258632.mp3", "video": ""}, {"text": "Which of the following statements about the anatomy of the nose are true? The anterior sloping part of the roof of the nose is formed by the nasal bones. The floor of the nose is formed by the cribriform plate of the ethmoid bone. The posterior sloping part of the roof of the nose is formed by the body of the sphenoid bone. The anterior three-fourths of the floor of the nose is formed by the palatine process of the maxilla. The posterior one-fourth of the floor of the nose is formed by the horizontal part of the sphenoid bone.", "options": [{"label": "A", "text": "Only 2", "correct": false}, {"label": "B", "text": "2, 5", "correct": false}, {"label": "C", "text": "1, 3, 4", "correct": true}, {"label": "D", "text": "1, 4, 5", "correct": false}], "correct_answer": "C. 1, 3, 4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8bhKBSBYFaVNEnhorjJ81738617386.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Roof of the nose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Floor of the nose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anterior Sloping Part</strong>: Formed by the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bones. <strong>(Statement 1)</strong></li>\n<li><strong>Posterior Sloping Part</strong>: Formed by the body of the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> bone. <strong>(Statement 3)</strong></li>\n<li><strong>Middle <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">Horizontal</span> Part</strong>: Formed by the <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate of the <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> bone (passage of <span class=\"customMeta\" data-dictid=\"30cac2b1a216927771941c69ff66a3\">olfactory</span> nerves into the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity). <strong>(Statement 2)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anterior Three-Fourths</strong>: Formed by the <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> process of the maxilla. <strong>(Statement 4)</strong></li>\n<li><strong>Posterior One-Fourth</strong>: Formed by the <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> part of the <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> bone. <strong>(Statement 5)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LeCGGW2jOpBHW6mjlEP51745258315.mp3", "video": ""}, {"text": "What is the primary function of the nasal valve in the nasal respiratory system?", "options": [{"label": "A", "text": "To provide resonance to the voice", "correct": false}, {"label": "B", "text": "Regulating airflow resistance and airflow dynamics", "correct": true}, {"label": "C", "text": "Modulating the temperature and humidity of inspired air", "correct": false}, {"label": "D", "text": "Sensing and processing olfactory stimuli", "correct": false}], "correct_answer": "B. Regulating airflow resistance and airflow dynamics", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dAEQh3eRRfyuG7n37n5m1745257750.mp3", "video": ""}, {"text": "Match the following in relation to the internal anatomy of the nose. a. Anterior 1. Nasal septum b. Lateral 2. Choanae c. Medial 3. Vestibule d. Posterior 4. Lateral wall of nose", "options": [{"label": "A", "text": "a-3, b-4, c-1, d-2", "correct": true}, {"label": "B", "text": "a-2, b-3, c-1, d-4", "correct": false}, {"label": "C", "text": "a-1, b-2, c-3, d-4", "correct": false}, {"label": "D", "text": "a-4, b-3, c-4, d-2", "correct": false}], "correct_answer": "A. a-3, b-4, c-1, d-2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CzQVjk0tR0ItMmde5fs11738617301.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vestibule</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Choanae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Roof</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Roof of the nose separates the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> from the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Floor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The floor of the nose separates the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> from the oral cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medial</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Septum: separates the right side of the nose from the left side</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall of the nose</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0ENpsIorkeY3BXuiVIYM1745256985.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 28 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 11 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 42 y/o woman with a history of nasal surgery presents with a depressed nasal bridge and difficulty breathing through her nose. Examination reveals a significant depression involving both the bony and cartilaginous parts of her nose. What would be the treatment approach for this patient?", "options": [{"label": "A", "text": "A cartilage graft from the nasal septum", "correct": false}, {"label": "B", "text": "Cancellous bone graft from the iliac crest", "correct": true}, {"label": "C", "text": "Silicone implant", "correct": false}, {"label": "D", "text": "Observation without intervention", "correct": false}], "correct_answer": "B. Cancellous bone graft from the iliac crest", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NaO8I2VTs77NDE3GKEwx1745319850.mp3", "video": ""}, {"text": "A 28 y/o woman presents with concerns about a prominent nasal hump. What is the primary treatment option for correction?", "options": [{"label": "A", "text": "Reduction rhinoplasty", "correct": true}, {"label": "B", "text": "Augmentation rhinoplasty", "correct": false}, {"label": "C", "text": "Septoplasty", "correct": false}, {"label": "D", "text": "Nasal steroid therapy", "correct": false}], "correct_answer": "A. Reduction rhinoplasty", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qIFipMkHH6fkIGK3cE8D1738731401.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/UKf6FQ9Qq2hawFKBgGca1745320085.mp3", "video": ""}, {"text": "A 30 y/o man presents with a nose that appears curved from the front, giving it an S-shaped appearance. He reports a history of facial trauma during childhood. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Crooked nose", "correct": true}, {"label": "B", "text": "Deviated nose", "correct": false}, {"label": "C", "text": "Septal hematoma", "correct": false}, {"label": "D", "text": "Saddle nose deformity", "correct": false}], "correct_answer": "A. Crooked nose", "question_images": ["https://image.prepladder.com/content/0QPnbhsQzJr5kpXTozic1738731641.png"], "explanation_images": ["https://image.prepladder.com/content/EZnvHO1nRKsEeWNWoHVP1738731688.png", "https://image.prepladder.com/content/2IpQZ16xE0c3AqzxB5k01738731718.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/AtCFDH32caI0WZ9yMZyQ1745321210.mp3", "video": ""}, {"text": "A 55-year-old man has a pink, lobulated mass on his nose with visible blood vessels, causing cosmetic and breathing concerns. Which treatment is best for minimal scarring?", "options": [{"label": "A", "text": "Cryotherapy", "correct": false}, {"label": "B", "text": "Surgical paring", "correct": false}, {"label": "C", "text": "Topical antibiotics", "correct": false}, {"label": "D", "text": "Carbon dioxide laser ablation", "correct": true}], "correct_answer": "D. Carbon dioxide laser ablation", "question_images": ["https://image.prepladder.com/content/QobSIc9mgmL3VPsPcTv81738731793.png"], "explanation_images": ["https://image.prepladder.com/content/qSkH3hi4uQ2dzldxeKaH1738731840.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/JgoxCp7CQtBA46ExlJA51745321454.mp3", "video": ""}, {"text": "A 55-year-old woman presents with a slowly growing ulcerated lesion on the tip of her nose, which has rolled edges and has been present for several months. There is no regional lymphadenopathy or pain. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Basal cell carcinoma", "correct": true}, {"label": "C", "text": "Malignant melanoma", "correct": false}, {"label": "D", "text": "Sebaceous adenoma", "correct": false}], "correct_answer": "B. Basal cell carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hHF5L2isVSTjXsRKgUA11738731898.png", "https://image.prepladder.com/content/YFQYBxcNqMXN7lSWy8TG1738731987.png", "https://image.prepladder.com/content/ThHEh7rmtksoVdzKm1RA1738731939.png", "https://image.prepladder.com/content/jzV65C3Ed3599dbGCtJl1738732025.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Basal cell carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Squamous cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The most common <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> tumour of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> skin (87%).</li>\n<li>Affects both males and females aged 40-60 years.</li>\n<li>Also known as <span class=\"customMeta\" data-dictid=\"57d1018b9d1692777197393d47bd6a\">Rodent</span> ulcer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Second most common <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> skin <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> (11%).</li>\n<li>Affects both sexes aged 40-60 years.</li>\n<li>Also known as Epithelioma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is caused by exposure to UV radiation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Occupational exposure to formaldehyde, chrome, nickel, arsenic and welding fumes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tip and <span class=\"customMeta\" data-dictid=\"eaa99cd1ab16927771803509d276b7\">ala</span> of the nose.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Side of nose or columella.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cyst, papulo-pearly nodule, or <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with rolled edges.</li>\n<li>Slow-growing, confined to skin for a long time, may invade <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> or bone.</li>\n<li>Nodal <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> are extremely rare.</li>\n</ul>\n<p><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Basal-cell_carcinoma#/media/File:Basal_cell_carcinoma2.JPG\" data-tags=\"\" height=\"2629\" src=\"https://image.prepladder.com/content/hHF5L2isVSTjXsRKgUA11738731898.png\" width=\"4167\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infiltrating <span class=\"customMeta\" data-dictid=\"6e6233ba551692777193c62c40bd5f\">nodule</span> or <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> with rolled-out edges.</li>\n<li>Nodal <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> occur in 20% of cases.</li>\n</ul>\n<p> </p>\n<p><img alt=\"\" data-author=\"Dermanonymous\" data-hash=\"\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Squamous_Cell_Carcinoma,_Right_Upper_Cheek.png#/media/File:Squamous_Cell_Carcinoma,_Right_Upper_Cheek.png\" data-tags=\"\" height=\"3719\" src=\"https://image.prepladder.com/content/YFQYBxcNqMXN7lSWy8TG1738731987.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Basal_cell_carcinoma_-_2_-_intermed_mag.jpg\" data-tags=\"\" height=\"2702\" src=\"https://image.prepladder.com/content/ThHEh7rmtksoVdzKm1RA1738731939.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"Valerie R. Yanofsky, Stephen E.Mercer, and Robert G. Phelps\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Micrograph_of_squamous_cell_carcinoma_in_situ_-_100x.jpg\" data-tags=\"\" height=\"3245\" src=\"https://image.prepladder.com/content/jzV65C3Ed3599dbGCtJl1738732025.png\" width=\"4167\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early lesions: cryosurgery, irradiation, or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with a 3-5 mm healthy margin.</li>\n<li>Advanced/recurrent lesions: <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> with local or <span class=\"customMeta\" data-dictid=\"65f3ce953e169277718673e6caa365\">distant flap</span> or <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> repair.</li>\n<li>Moh’s surgery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Early lesions: radiotherapy.</li>\n<li>Advanced lesions with cartilage/bone exposure: wide <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and plastic repair.</li>\n<li>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> involvement: block dissection.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hlXSUgboaBLYDlWir6ff1745321718.mp3", "video": ""}, {"text": "A 30-year-old male presents with chronic nasal obstruction, headaches, and frequent nosebleeds. On examination, there is a shelf-like projection felt along the nasal septum. The image below describes the obstruction. What is the most likely cause of this patient's symptoms?", "options": [{"label": "A", "text": "Anterior dislocation of the septum", "correct": false}, {"label": "B", "text": "C-shaped deformity", "correct": false}, {"label": "C", "text": "Septal spur", "correct": true}, {"label": "D", "text": "S-shaped deformity", "correct": false}], "correct_answer": "C. Septal spur", "question_images": ["https://image.prepladder.com/content/ShMindZmjIKZ9qXrAA5X1738732133.png"], "explanation_images": ["https://image.prepladder.com/content/Qaef5OD4uGc9r8D3npXP1738732193.png", "https://image.prepladder.com/content/e46E9QCafJgbNVvWtoW31738732212.png", "https://image.prepladder.com/content/PGSYZTrWElSJ7MOhvXCk1738732255.png", "https://image.prepladder.com/content/CdXkwTnOD5YY2bvP11MM1738732283.png", "https://image.prepladder.com/content/ZZklcTesFMz0V72FFv5S1738732306.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:572px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types of Deviated <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">Septum</span> (DNS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior Dislocation</strong></p>\n<p style=\"text-align:center\"><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Displacement of septal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> to one <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> chamber.</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1487\" src=\"https://image.prepladder.com/content/Qaef5OD4uGc9r8D3npXP1738732193.png\" width=\"1644\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>C-shaped Deformity </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple curve to one side, wider <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> chamber on the <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> side with possible <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> hypertrophy</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1545\" src=\"https://image.prepladder.com/content/e46E9QCafJgbNVvWtoW31738732212.png\" width=\"1654\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>S-shaped Deformity </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deviation in a vertical or <span class=\"customMeta\" data-dictid=\"c12a40cc401692777181852b507764\">anteroposterior</span> plane leads to <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction.</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/PGSYZTrWElSJ7MOhvXCk1738732255.png\" width=\"4167\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Spurs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shelf-like projections at bone-cartilage <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> causing headache or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> epistaxis</p>\n<img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"1518\" src=\"https://image.prepladder.com/content/CdXkwTnOD5YY2bvP11MM1738732283.png\" width=\"1650\"/><br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Thickening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Due to organized <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or <span class=\"customMeta\" data-dictid=\"1cc334f67c16927771940925dd1381\">overriding</span> of septal fragments</p>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/ZZklcTesFMz0V72FFv5S1738732306.png\" width=\"4167\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2brXtVz9EM2fwTieLF4V1745321912.mp3", "video": ""}, {"text": "Which of the following statements is true regarding the clinical features and complications of a deviated nasal septum (DNS)?", "options": [{"label": "A", "text": "Nasal obstruction is less severe when the upper part of the septum is deviated.", "correct": false}, {"label": "B", "text": "Septal spurs rarely cause headaches.", "correct": false}, {"label": "C", "text": "DNS can cause anosmia.", "correct": true}, {"label": "D", "text": "Cottle’s test is used to diagnose choanal atresia in patients with DNS.", "correct": false}], "correct_answer": "C. DNS can cause anosmia.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vy35m989CQXHiaOrQZdf1738732382.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:516px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasal Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unilateral or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> obstruction, more severe in high septal deviations<strong> </strong><strong>(Option A ruled out)</strong>.</li>\n<li>Obstruction sites can include vestibular, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> valves, attic, turbinal, or <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> regions.</li>\n<li><strong>Cottle Test</strong>: Positive if the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> improves when the cheek is pulled laterally (indicates <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> abnormality). <strong>(Option D ruled out)</strong></li>\n</ul>\n<p><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NAN\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/vy35m989CQXHiaOrQZdf1738732382.png\" width=\"4167\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Headache</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pressure from septal spurs against the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> wall of the nose causes a pressure-type headache <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinusitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DNS can block <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> ostia, leading to poor <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> and a <span class=\"customMeta\" data-dictid=\"6fc754288b1692777196b7664d3a9a\">predisposition</span> to <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> infections.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epistaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Drying and <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">crust</span> formation over the deviated <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> can cause <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> upon removal of crusts.</li>\n<li>Bleeding can also occur from vessels on septal spurs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anosmia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Partial or total loss of smell due to failure of air to reach the <span class=\"customMeta\" data-dictid=\"30cac2b1a216927771941c69ff66a3\">olfactory</span> region.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>External Deformity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visible <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> deformities such as <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> or deformities of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> tip or columella.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle Ear Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DNS predisposes to <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> infections due to poor <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">ventilation</span> through the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/koAVnDYA24VOl69FkAUG1745322118.mp3", "video": ""}, {"text": "A 15-year-old with a deviated nasal septum, significant nasal obstruction, and frequent sinus infections has a deviation mainly anterior to Cottle’s line, with no growth concerns. Which statement is true regarding surgical management?", "options": [{"label": "A", "text": "Submucous resection (SMR) can be done in a 10-year-old child.", "correct": false}, {"label": "B", "text": "Septoplasty is preferred for limited dissection, with no impact on nasal growth in children.", "correct": true}, {"label": "C", "text": "SMR is preferred due to limited dissection and lower complication rates than septoplasty.", "correct": false}, {"label": "D", "text": "SMR is preferred for safer reoperation and anterior deviations.", "correct": false}], "correct_answer": "B. Septoplasty is preferred for limited dissection, with no impact on nasal growth in children.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7C15w89gg6PBM0SkrFSD1738732469.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Submucous Resection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Septoplasty</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extent of Dissection</strong></p>\n<br/>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensive dissection, removing all deformed bony and <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> parts, preserving only a <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> strut.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Limited, selective dissection, removing minimal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and bone, preserving most of the framework. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Consideration</strong></p>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not performed before 17 years to avoid <span class=\"customMeta\" data-dictid=\"f087a3103216927771903f59008962\">interference</span> with <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> growth. <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Can be performed in children without affecting <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> growth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Flap Elevation</strong></p>\n<br/>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flaps are raised on both sides of the septum.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flap raised on one side with limited <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> on the opposite side</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment of Deformed Parts</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bony and <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> parts are excised.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deformed <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> is corrected by scoring, cross-hatching, <span class=\"customMeta\" data-dictid=\"b3c25aa68616927772025ab4ff7a11\">wedge</span> excision, or realigning after external <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> (extracorporeal septoplasty).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Complications</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Higher chances of complications (e.g., <span class=\"customMeta\" data-dictid=\"b9ebf200411692777199f24bffc7a8\">supra</span> tip depression, columellar recession, flapping of septum).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower chances of complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reoperation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reoperation is difficult.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reoperation is easier.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qS5Y63jGbaTq8X0Dqype1745322547.mp3", "video": ""}, {"text": "A 30 y/o man presents with bilateral nasal obstruction, frontal headache, and a feeling of pressure over the nasal bridge following a recent nasal injury. On examination, a smooth, rounded, soft, and fluctuant swelling is noted in both nasal cavities. Which of the following is the most appropriate management step for this condition?", "options": [{"label": "A", "text": "Nasal packing.", "correct": false}, {"label": "B", "text": "Use cryotherapy to manage the nasal swelling", "correct": false}, {"label": "C", "text": "Use of systemic antibiotics without drainage.", "correct": false}, {"label": "D", "text": "Incision and drainage, followed by nasal packing.", "correct": true}], "correct_answer": "D. Incision and drainage, followed by nasal packing.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nct8ZLK8xKlHR917aX5f1738732530.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:530px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collection of blood under the <span class=\"customMeta\" data-dictid=\"f6fce4967b16927771956fcb228bb9\">perichondrium</span> or <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum.</li>\n<li>Commonly caused by:\n\t\t\t\t<ul>\n<li>Nasal trauma.</li>\n<li>Septal surgery.</li>\n<li>Spontaneous occurrence in <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (most common symptom).</li>\n<li>Fontal headache and pressure over the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bridge.</li>\n<li>Smooth, rounded, soft, and <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in both <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"919be7b0a31692777203eb1a856f99\">fossae</span> (or sometimes unilateral).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Small hematomas:</u> Aspirated with a wide-bore <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> needle.</li>\n<li><u>Larger hematomas:</u> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">Incision</span> and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> via a septal <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> floor, excising a small piece of <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> for better drainage.</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> on both sides to prevent reaccumulation.</li>\n<li>Systemic antibiotics to prevent septal abscess.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrous tissue formation leads to permanent septal thickening if untreated.</li>\n<li>Secondary infection may lead to septal abscess, <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> necrosis, and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> depression.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Hv5qYKr3TodCgGHQGYad1745322862.mp3", "video": ""}, {"text": "A 45-year-old man with a history of trauma 1 week back, presents with fever, frontal headache, nasal bridge redness, and septal tenderness. O/E there smooth bilateral swelling of the nasal septum. What should be the initial approach to managing this patient's condition?", "options": [{"label": "A", "text": "Immediate drainage", "correct": true}, {"label": "B", "text": "Observation and follow-up in a week", "correct": false}, {"label": "C", "text": "Nasal decongestants", "correct": false}, {"label": "D", "text": "Corticosteroid therapy", "correct": false}], "correct_answer": "A. Immediate drainage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WXabGsr7VrzV821oca041738732603.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XaQRYpHKWrPAexSnt3vt1745323206.mp3", "video": ""}, {"text": "A 35-year-old man presents with nasal obstruction and frequent crusting. Examination reveals a large perforation in the nasal septum. What is the most appropriate initial management?", "options": [{"label": "A", "text": "Surgical closure with plastic flaps", "correct": false}, {"label": "B", "text": "Cauterization of the perforation", "correct": false}, {"label": "C", "text": "Use of steroid nasal sprays", "correct": false}, {"label": "D", "text": "Application of saline nasal washes and insertion of septal button", "correct": true}], "correct_answer": "D. Application of saline nasal washes and insertion of septal button", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ycaExX1bjZRmps0dPYj81738732685.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TNSfNT08xgpQCWLi1ZDd1745323499.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 21 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 22 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 12-year-old patient presents with a history of sinusitis and now has swollen, red eyelids, pain with eye movement, and restricted extraocular motion. There is no proptosis, and CT imaging shows diffuse inflammation of the orbital tissues without abscess formation. According to Chandler's classification, what is the most likely stage of this condition?", "options": [{"label": "A", "text": "Preseptal cellulitis", "correct": false}, {"label": "B", "text": "Orbital cellulitis", "correct": true}, {"label": "C", "text": "Subperiosteal abscess", "correct": false}, {"label": "D", "text": "Orbital abscess", "correct": false}], "correct_answer": "B. Orbital cellulitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/SxEA0TuM7AlRRjQwY14o1738730402.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Chandler’s <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> Cellulitis</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>I - <span class=\"customMeta\" data-dictid=\"788578009c1692777196a0a397bdc4\">Preseptal</span> cellulitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection confined to the eyelid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eyelid swelling, no <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>II - <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> cellulitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection spreads to the orbit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain with eye movement, restricted mobility, no <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>III - <span class=\"customMeta\" data-dictid=\"98c8f7f96f1692777199295afb1d35\">Subperiosteal</span> abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pus collection beneath periosteum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Localized pus, proptosis, pain on movement, swelling</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IV - <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pus collection within the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> tissues</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe proptosis, potential vision loss, risk of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>V - <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">Cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spread of infection to the <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> sinus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral eye involvement, headache, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsies</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/kHDd2GdTRQe5FDS93AzI1746638229.mp3", "video": ""}, {"text": "During a total maxillectomy for an extensive malignant tumor, the surgeon is required to remove several structures to ensure complete resection. Which of the following structures is not typically removed during this procedure?", "options": [{"label": "A", "text": "Hard palate", "correct": false}, {"label": "B", "text": "Orbital floor", "correct": false}, {"label": "C", "text": "Ethmoid sinus", "correct": false}, {"label": "D", "text": "Zygomatic arch", "correct": true}], "correct_answer": "D. Zygomatic arch", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:646px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Removed</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medial Maxillectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Middle turbinate</li>\n<li>Inferior turbinate</li>\n<li>Ethmoid sinus</li>\n<li>Maxillary sinus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infrastructural Maxillectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends to include the upper <span class=\"customMeta\" data-dictid=\"ef27885fbf1692777181edd3fc6be9\">alveolar ridge</span> &amp; adjoining <strong>hard palate</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subtotal Maxillectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the <strong>entire Maxilla.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total Maxillectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of all the above structures along with the <strong>Orbital Floor</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radical Maxillectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Total <span class=\"customMeta\" data-dictid=\"7e1612510d1692777192cfe698ecc1\">maxillectomy</span> plus <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> exenteration.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cekNK8nTwXWkYnfUYLzN1746639309.mp3", "video": ""}, {"text": "A 65-year-old man presents with nasal obstruction, facial swelling, and proptosis. Imaging reveals a malignancy in the Sinonasal region. According to Lederman’s classification, which of the following tumor locations is categorized as mesostructural ?", "options": [{"label": "A", "text": "Invasion of the cribriform plate.", "correct": false}, {"label": "B", "text": "Extension to the respiratory part of the nasal cavity.", "correct": true}, {"label": "C", "text": "Extending to sphenoid sinus and the orbit.", "correct": false}, {"label": "D", "text": "Tumor involving the Alveolar process.", "correct": false}], "correct_answer": "B. Extension to the respiratory part of the nasal cavity.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HvFohxFTcReMpRnxqoeg1738731069.png"], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Lederman's classification</li><li>↳ Horizontal Lines of Sebileau: These lines help delineate the categories by passing through the floors of the orbits and the antra. Vertical Lines: Extend down the medial walls of the orbit, separating the ethmoid sinuses and nasal fossa from the maxillary sinuses. Areas Structures Involved Prognosis Suprastructure Ethmoid Sphenoid (Option C) Frontal sinuses Olfactory area of the nose (Option A) . Poor prognosis Mesostructure Maxillary sinus Respiratory part of the nasal cavity. Better prognosis than suprastructural category. Infrastructure Alveolar process (Option D) of maxilla Better Prognosis</li><li>↳ Horizontal Lines of Sebileau: These lines help delineate the categories by passing through the floors of the orbits and the antra.</li><li>↳ Horizontal Lines of Sebileau:</li><li>↳ Vertical Lines: Extend down the medial walls of the orbit, separating the ethmoid sinuses and nasal fossa from the maxillary sinuses.</li><li>↳ Vertical Lines:</li><li>↳ Areas Structures Involved Prognosis Suprastructure Ethmoid Sphenoid (Option C) Frontal sinuses Olfactory area of the nose (Option A) . Poor prognosis Mesostructure Maxillary sinus Respiratory part of the nasal cavity. Better prognosis than suprastructural category. Infrastructure Alveolar process (Option D) of maxilla Better Prognosis</li><li>↳ Areas Structures Involved Prognosis Suprastructure Ethmoid Sphenoid (Option C) Frontal sinuses Olfactory area of the nose (Option A) . Poor prognosis Mesostructure Maxillary sinus Respiratory part of the nasal cavity. Better prognosis than suprastructural category. Infrastructure Alveolar process (Option D) of maxilla Better Prognosis</li><li>↳ Areas Structures Involved Prognosis</li><li>↳ Areas</li><li>↳ Areas</li><li>↳ Areas</li><li>↳ Structures Involved</li><li>↳ Structures Involved</li><li>↳ Structures Involved</li><li>↳ Prognosis</li><li>↳ Prognosis</li><li>↳ Prognosis</li><li>↳ Suprastructure Ethmoid Sphenoid (Option C) Frontal sinuses Olfactory area of the nose (Option A) . Poor prognosis</li><li>↳ Suprastructure</li><li>↳ Suprastructure</li><li>↳ Suprastructure</li><li>↳ Ethmoid Sphenoid (Option C) Frontal sinuses Olfactory area of the nose (Option A) .</li><li>↳ Ethmoid Sphenoid (Option C) Frontal sinuses Olfactory area of the nose (Option A) .</li><li>↳ Ethmoid</li><li>↳ Sphenoid (Option C)</li><li>↳ (Option C)</li><li>↳ Frontal sinuses</li><li>↳ Olfactory area of the nose (Option A) .</li><li>↳ (Option A)</li><li>↳ Poor prognosis</li><li>↳ Poor prognosis</li><li>↳ Poor prognosis</li><li>↳ Mesostructure Maxillary sinus Respiratory part of the nasal cavity. Better prognosis than suprastructural category.</li><li>↳ Mesostructure</li><li>↳ Mesostructure</li><li>↳ Mesostructure</li><li>↳ Maxillary sinus Respiratory part of the nasal cavity.</li><li>↳ Maxillary sinus Respiratory part of the nasal cavity.</li><li>↳ Maxillary sinus</li><li>↳ Respiratory part of the nasal cavity.</li><li>↳ Respiratory part of the nasal cavity.</li><li>↳ Better prognosis than suprastructural category.</li><li>↳ Better prognosis than suprastructural category.</li><li>↳ Infrastructure Alveolar process (Option D) of maxilla Better Prognosis</li><li>↳ Infrastructure</li><li>↳ Infrastructure</li><li>↳ Infrastructure</li><li>↳ Alveolar process (Option D) of maxilla</li><li>↳ Alveolar process (Option D) of maxilla</li><li>↳ Alveolar process</li><li>↳ (Option D)</li><li>↳ Better Prognosis</li><li>↳ Better Prognosis</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Areas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suprastructure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ethmoid</li>\n<li>Sphenoid <strong>(Option C)</strong></li>\n<li>Frontal sinuses</li>\n<li>Olfactory area of the nose <strong>(Option A)</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Poor prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mesostructure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Maxillary sinus</li>\n<li><strong>Respiratory part of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Better <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> than suprastructural category.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infrastructure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alveolar process</strong> <strong>(Option D) </strong>of maxilla</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Better Prognosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/nABIarMuRsGaYEBcZjnP1746639493.mp3", "video": ""}, {"text": "A 62-year-old man presents with nasal obstruction and facial swelling. Imaging shows a malignancy in the maxillary sinus. The oncologist uses Ohngren’s line to assess the prognosis. According to Ohngren’s line, which tumour location indicates a better prognosis?", "options": [{"label": "A", "text": "Above Ohngren’s line", "correct": false}, {"label": "B", "text": "Below Ohngren’s line", "correct": true}, {"label": "C", "text": "Along the Ohngren’s line", "correct": false}, {"label": "D", "text": "Involvement of Frontal sinus", "correct": false}], "correct_answer": "B. Below Ohngren’s line", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/w26W3qZPH2YROZYYuByj1738730991.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hFat1ZrHcu0yRJHnH1kQ1746639745.mp3", "video": ""}, {"text": "A 55-year-old male carpenter presents with symptoms of persistent nasal congestion, facial swelling, and occasional nasal bleeding. He has a long history of working in the hardwood furniture industry for 30 years. CT scan reveals findings, as shown in the image. Which type of carcinoma is he most at risk for?", "options": [{"label": "A", "text": "Squamous Cell Carcinoma", "correct": false}, {"label": "B", "text": "Adenocarcinoma", "correct": true}, {"label": "C", "text": "Small Cell Carcinoma", "correct": false}, {"label": "D", "text": "Basal Cell Carcinoma", "correct": false}], "correct_answer": "B. Adenocarcinoma", "question_images": ["https://image.prepladder.com/content/1Z7U8o85JJnzqXU7LuJh1738730884.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Frontal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> (M/C), followed by <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> and maxillary sinuses.</li>\n<li>Often asymptomatic; discovered incidentally on X-rays.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fibrous Dysplasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mostly affects maxillary sinus</li>\n<li>Causes Facial disfigurement, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction, eye displacement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ossifying Fibroma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in young adults &amp; tumours are easily shellable.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ameloblastoma (Adamantinoma)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arises from <span class=\"customMeta\" data-dictid=\"9eb736a7f916927771941b4b94754e\">odontogenic</span> tissue, invades maxillary sinus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rare Tumors:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inverted papilloma, Meningioma, and Hemangioma.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qSTzMU4IBq3UY5ehzt9D1746639925.mp3", "video": ""}, {"text": "A 45-year-old patient presents with nasal obstruction, epistaxis, and anosmia. A CT scan reveals an invasive mass in the nasal cavity, and a biopsy confirms the diagnosis of olfactory neuroblastoma. Which classification system is commonly used to stage olfactory neuroblastoma?", "options": [{"label": "A", "text": "Kadish Classification", "correct": true}, {"label": "B", "text": "Breslow Classification", "correct": false}, {"label": "C", "text": "Ann Arbor Staging classification", "correct": false}, {"label": "D", "text": "Gleason Classification", "correct": false}], "correct_answer": "A. Kadish Classification", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:519px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour limited to the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour involving the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and sinuses.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour extending beyond the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> and <span class=\"customMeta\" data-dictid=\"e23ca9914316927771948eba43a1e9\">paranasal</span> sinuses.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor with <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> to <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> nodes or distant sites.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/07gKnFKa6MtsLzDL6Ezq1745316983.mp3", "video": ""}, {"text": "A 32-year-old patient presents with a history of frontal headache, noticeable swelling on the forehead, and a recent episode of sinusitis. Physical examination reveals a soft, doughy swelling over the frontal bone, and a CT scan shows a subperiosteal abscess with associated bone erosion. What is the likely diagnosis?", "options": [{"label": "A", "text": "Frontal Sinus Mucocele", "correct": false}, {"label": "B", "text": "Pott's Puffy Tumour", "correct": true}, {"label": "C", "text": "Frontal Sinus Abscess", "correct": false}, {"label": "D", "text": "Frontal Sinus Osteoma", "correct": false}], "correct_answer": "B. Pott's Puffy Tumour", "question_images": ["https://image.prepladder.com/content/RekQnfq2myr6X2p5prcl1738730777.png"], "explanation_images": ["https://image.prepladder.com/content/hMZ3iYLFkrk1FrTDkKe41738730826.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/1vQlvAizUnjhpSpnXMxI1746640090.mp3", "video": ""}, {"text": "Match the following conditions with their most commonly affected sinuses: Conditions Most Commonly Affected Sinus 1. Osteoma a. Maxillary sinus 2. Fibrous Dysplasia b. Ethmoid sinus 3. Chronic Rhinosinusitis with Nasal Polyps c. Frontal sinus", "options": [{"label": "A", "text": "1-a, 2-b, 3-c", "correct": false}, {"label": "B", "text": "1-c, 2-a, 3-b", "correct": true}, {"label": "C", "text": "1-b, 2-c, 3-a", "correct": false}, {"label": "D", "text": "1-a, 2-c, 3-b", "correct": false}], "correct_answer": "B. 1-c, 2-a, 3-b", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/y2G9tTm5l6I6Nk8d6SRU1738730647.png", "https://image.prepladder.com/content/mtW4s36iLGUPS7KQABPA1738730679.png", "https://image.prepladder.com/content/zS53VubWavp7azhvXROj1738730708.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:713px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Most Common Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Osteoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign, slow-growing bony tumor affecting the <span class=\"customMeta\" data-dictid=\"e23ca9914316927771948eba43a1e9\">paranasal</span> sinuses.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frontal sinus</strong> (most common), ethmoid, maxillary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often asymptomatic; may cause <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> obstruction, <span class=\"customMeta\" data-dictid=\"0ad4e5da4a16927771938fd4d86a52\">mucocele</span> formation, pressure symptoms (headache, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> involvement).</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observation for <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> cases; <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> for deformity, obstruction, or <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibrous Dysplasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign <span class=\"customMeta\" data-dictid=\"e301bf525b1692777202e8e0c0a3d6\">fibro-osseous</span> condition where bone is replaced by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue, causing structural weakness and deformity.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maxillary <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> </strong>(most common), ethmoid, frontal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facial disfigurement, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction, eye displacement, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> pain, and swelling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Chronic Rhinosinusitis with <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Polyps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> condition with <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> polyps formation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ethmoid sinuses</strong> (most common)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nasal obstruction, <span class=\"customMeta\" data-dictid=\"785b6d19ba16927771965c071acb28\">postnasal</span> drip, anosmia/hyposmia, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> pressure, secondary infections, <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> into orbit or brain.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medical management (corticosteroids, antihistamines, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> irrigations); surgery (FESS) for obstructive polyps.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qhTrzmrt7ZHLfv84BxL81746640219.mp3", "video": ""}, {"text": "A 55-year-old male presents with unilateral nasal obstruction, epistaxis, and a mass in the right nasal cavity. Nasal endoscopy reveals a mass arising from the lateral nasal wall with displacement of the middle turbinate. Biopsy confirms the diagnosis of inverted papilloma. All of the following are true regarding inverted papilloma except?", "options": [{"label": "A", "text": "It is malignant at presentation.", "correct": true}, {"label": "B", "text": "It is associated with Human Papillomavirus type 6 and11.", "correct": false}, {"label": "C", "text": "The primary treatment involves endoscopic surgical excision.", "correct": false}, {"label": "D", "text": "It commonly arises from the non-olfactory mucosa.", "correct": false}], "correct_answer": "A. It is malignant at presentation.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oWhJUDtnEuPsIUZ0uCNe1738730561.png", "https://image.prepladder.com/content/6bEp3Bo53pLcgJH8Fbtw1738730590.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inverted Papilloma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arises from the <strong>non-olfactory mucosa</strong> (Schneiderian membrane) of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and <span class=\"customMeta\" data-dictid=\"e23ca9914316927771948eba43a1e9\">paranasal</span> sinuses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Names</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transitional cell papilloma, Ringertz tumor, <span class=\"customMeta\" data-dictid=\"bd7a7ca72b1692777198cc8650712f\">Schneiderian</span> papilloma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most Common Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral wall of the nose</strong>, particularly in the <strong>middle meatus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inward growth</strong> of hyperplastic tissue toward the stroma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Association with HPV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Linked to <span class=\"customMeta\" data-dictid=\"772d623b06169277718976e9488c37\">Human Papillomavirus</span> (HPV)</strong> infection (particularly types<strong> 6 and 11</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>squamous cell carcinoma</strong> in <strong>10-15%</strong> of cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction, <span class=\"customMeta\" data-dictid=\"26bb4e3cc81692777187ce44e530e5\">epistaxis</span> (nosebleeds), and possible <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic examination and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for histopathological confirmation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary treatment is <strong>complete <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> excision</strong> to minimize the risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> and <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/NLcePXijO5rCBZjDYeBl1746640363.mp3", "video": ""}, {"text": "A 45-year-old male with a history of chronic sinusitis presents with worsening frontal headaches, orbital pain, diplopia, and ptosis. Examination reveals limited eye movements, decreased sensation over the forehead, and mild proptosis. Superior Orbital Fissure Syndrome (SOFS) is suspected. Which cranial nerve is not involved in SOFS?", "options": [{"label": "A", "text": "CN II", "correct": true}, {"label": "B", "text": "CN III", "correct": false}, {"label": "C", "text": "CN IV", "correct": false}, {"label": "D", "text": "CN VI", "correct": false}], "correct_answer": "A. CN II", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CgLFkIRTJyWZouKxOk9U1738730508.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">Fissure</span> Syndrome (SOFS)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"b2af124a931692777203c9f8031b77\">fissure</span> (between lesser and greater wings of <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> bone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cranial Nerves (CN III, IV, VI,V<strong>1</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infections (sphenoid sinusitis, <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis)</p>\n<p>Tumors (meningioma, <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> carcinoma, metastases)</p>\n<p>Trauma (sphenoid fractures)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ophthalmoplegia (eye movement paralysis), <span class=\"customMeta\" data-dictid=\"e18c2053271692777194e62a208e01\">ptosis</span> (drooping eyelid), <span class=\"customMeta\" data-dictid=\"1458c330411692777186cd49bb6a30\">diplopia</span> (double vision), <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> headache.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Potential Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vision loss, impaired eye movement, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"a6a2c6342d1692777193c3414d0cc8\">numbness</span> or pain</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Kjd2YRPnR5G4tRhEck411746639180.mp3", "video": ""}, {"text": "A 35-year-old patient presents with a recent history of sinusitis. The patient has sudden-onset high fever, severe headache, eyelid swelling, and restricted eye movements. Examination reveals bilateral proptosis and sequential cranial nerve palsies. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Orbital cellulitis", "correct": false}, {"label": "B", "text": "Cavernous sinus thrombosis", "correct": true}, {"label": "C", "text": "Subperiosteal abscess", "correct": false}, {"label": "D", "text": "Preseptal cellulitis", "correct": false}], "correct_answer": "B. Cavernous sinus thrombosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BDaJyYpm5FB04EDULPgM1738730452.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cavernous <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> Thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orbital <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">Cellulitis</span> </strong><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden, high fever and headache.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual, starts with <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> swelling.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frequently bilateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically unilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cranial Nerve Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sequential <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> of CN III, IV, V1, VI</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may involve <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Proptosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"4edef7912e1692777196cb0f66e35d\">proptosis</span> common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> proptosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More likely to cause severe visual loss</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can cause visual <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> but is less severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Source of Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Broad (sinusitis, pharyngitis, ear, orbit)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Typically, it is from <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> sinusitis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rBuu08UykBfQriNmQCVv1746638979.mp3", "video": ""}, {"text": "A 32-year-old patient has been experiencing nasal congestion, facial pain, and nasal discharge for one week. Examination reveals maxillary sinus tenderness and nasal obstruction. The patient reports similar episodes resolving within 10-14 days. What is the most common cause of this condition?", "options": [{"label": "A", "text": "Deviated nasal septum", "correct": false}, {"label": "B", "text": "Allergic fungal sinusitis", "correct": false}, {"label": "C", "text": "Viral infection", "correct": true}, {"label": "D", "text": "Aspirin sensitivity", "correct": false}], "correct_answer": "C. Viral infection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Causes of Chronic Sinusitis</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contributing Factors</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patient Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomic structural deformities</strong>: <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> of <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> ostia (e.g., deviated septum, <span class=\"customMeta\" data-dictid=\"d132cd1b021692777184bb399da7e4\">concha</span> bullosa, <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> variations) <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lifestyle factors</strong>: Smoking, <span class=\"customMeta\" data-dictid=\"cf2e5db74f1692777198e270bb0ada\">snuff</span> dipping, prolonged use of <span class=\"customMeta\" data-dictid=\"7ce016ff5116927771905364aaefee\">intranasal</span> medications</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immune Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary</strong>: <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> deficiency, primary <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> dyskinesia, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acquired</strong>: HIV, prolonged <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use, chemotherapy, immunosuppressants in organ transplant patients, leukaemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspirin Sensitivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sensitivity to <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> causing chronic <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> inflammation. <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aeroallergens</strong>: Allergic rhinitis, asthma, exposure to allergens (dust, pollen, moulds)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxins and Chemicals</strong>: Exposure to pollution, occupational chemicals, and toxic gases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacteria (aerobic and anaerobic), fungi, mycobacteria</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ghiefM3iIVH1kkDQXap51745263674.mp3", "video": ""}, {"text": "A 32-year-old patient presents with sinusitis symptoms, including severe headache, nasal congestion, and fever. Examination reveals proptosis and restricted eye movements. A CT scan shows inflammation of the ethmoid sinuses. Which of the following is not a potential complication of sinusitis with orbital involvement?", "options": [{"label": "A", "text": "Orbital Cellulitis", "correct": false}, {"label": "B", "text": "Subperiosteal abscess", "correct": false}, {"label": "C", "text": "Orbital abscess", "correct": false}, {"label": "D", "text": "Sinus mucocele", "correct": true}], "correct_answer": "D. Sinus mucocele", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucocele</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It commonly involves <strong>Frontal sinus</strong></li>\n<li><strong>Presentation:</strong> <span class=\"customMeta\" data-dictid=\"9b328ed0df16927771992005b9c18e\">Superomedial</span> orbit (90% of cases) causing eye <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> forward, downward, and laterally; sometimes as <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the forehead (10%).</li>\n<li><strong>Symptoms:</strong> Mild headache, diplopia, and proptosis.</li>\n<li><strong>Imaging:</strong> Clouded <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> with <strong>loss of scalloped outline.</strong></li>\n<li><strong>Treatment:</strong> Frontoethmoidectomy and drainage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyocele (Mucopyocele)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Similar to <span class=\"customMeta\" data-dictid=\"0ad4e5da4a16927771938fd4d86a52\">mucocele</span> but contains <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> due to infection.</li>\n<li>Treatment involves <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> or external <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> drainage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Osteomyelitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maxilla:</strong></p>\n<ul>\n<li>More common in infants and children due to <span class=\"customMeta\" data-dictid=\"b2a22f1dff169277719977c0a8ee4a\">spongy</span> bone.</li>\n<li>Symptoms: Erythema, Swelling, and <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">Purulent</span> discharge.</li>\n</ul>\n<p><strong>Frontal Bone:</strong></p>\n<ul>\n<li>Often occurs in adults &amp; results from <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> infection of <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> sinus.</li>\n<li>Symptoms: Pott’s puffy tumour or an extradural, <span class=\"customMeta\" data-dictid=\"98c8f7f96f1692777199295afb1d35\">subperiosteal</span> <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> managed with <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <span class=\"customMeta\" data-dictid=\"599ab92ac4169277720019d93f72b8\">trephination</span> with Lynch Howarth incision.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sDaKSniJnAyqjVT6ryoP1746638100.mp3", "video": ""}, {"text": "A 55-year-old diabetic patient presents with facial swelling and necrotic nasal tissue, as shown in the image &amp;amp; visual changes. A diagnosis of acute invasive fungal rhinosinusitis (AIFR) is suspected. Which imaging modality is most appropriate for evaluating the extent of orbital/Intracranial involvement?", "options": [{"label": "A", "text": "Non-contrast CT", "correct": false}, {"label": "B", "text": "PET Scan", "correct": false}, {"label": "C", "text": "CE-MRI", "correct": true}, {"label": "D", "text": "CECT", "correct": false}], "correct_answer": "C. CE-MRI", "question_images": ["https://image.prepladder.com/content/H4enoFhWspXX3jQSlUxa1738730223.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A severe fungal infection primarily affects the nose and sinuses but can quickly spread to the orbit, <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate, meninges, and brain. The <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> invades arteries, causing endothelial damage, thrombosis, and rapid tissue destruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black necrotic material in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, eroding the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, hard palate, and turbinates. <strong>Black <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> sign</strong> is seen on contrast enhanced MRI.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uncontrolled diabetes, especially with ketoacidosis</li>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use (common in <span class=\"customMeta\" data-dictid=\"2d364aeaf7169277718529fa58f6ea\">COVID-19</span> treatment)</li>\n<li>Conditions causing immunosuppression: Neutropenia, HIV/AIDS, chemotherapy, organ transplants, and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> issues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Endoscopy:</strong> Shows pale <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> early, progressing to black crusts and sloughing.</li>\n<li><strong>Biopsy:</strong> Multiple sites should be sampled for fungal identification; <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"0a57b1bc5916927771895a4f4e60b4\">hydroxide</span> preparation is the <strong>gold standard</strong><strong> </strong>for confirming <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> features.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT</strong>: Detects bony destruction and initial assessment of <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> involvement.</li>\n<li><strong>CECT: </strong>CECT provides better delineation of soft tissue structures, allowing for <span class=\"customMeta\" data-dictid=\"55436411c216927771846e318f45ce\">clearer</span> identification of mucosal thickening, <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> opacification, and bony destruction.</li>\n<li><strong>MRI</strong>: Evaluates soft tissue invasion, assesses the extent of extra-sinus disease, and identifies complications, especially in the <strong>orbit and brain</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antifungal Therapy</strong>:</p>\n<ul>\n<li>Amphotericin B: 0.6 to 1 mg/kg/day IV or liposomal Amphotericin B: 5 mg/kg/day.</li>\n<li>Posaconazole: 300 mg twice daily orally on the first day, then 300 mg once daily.</li>\n</ul>\n<p><strong>Surgical Intervention</strong>:</p>\n<ul>\n<li>Endoscopic debridement of necrotic tissues.</li>\n<li>Severe cases: Total/Partial <span class=\"customMeta\" data-dictid=\"7e1612510d1692777192cfe698ecc1\">maxillectomy</span> or <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"b26b12affb16927771872ba42c137b\">exenteration</span> may be required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/h4abAfQyGy5qaL43QoxQ1746637758.mp3", "video": ""}, {"text": "A 45-year-old patient is evaluated for suspected allergic fungal rhinosinusitis (AFRS) using the Bent and Kuhn diagnostic criteria. Which of the following is not part of the Bent and Kuhn Major criteria for diagnosing AFRS?", "options": [{"label": "A", "text": "Nasal Polyposis", "correct": false}, {"label": "B", "text": "Eosinophilic mucin without fungal invasion", "correct": false}, {"label": "C", "text": "Positive fungal cultures", "correct": true}, {"label": "D", "text": "Positive Fungal stain", "correct": false}], "correct_answer": "C. Positive fungal cultures", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major Criteria</strong><strong> (must meet all)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor Criteria </strong><strong>(supportive)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Type I <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> (history, skin test, or <span class=\"customMeta\" data-dictid=\"16519ed6441692777190f7784d60d8\">in vitro</span> testing)</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"fe6b8df2fa1692777196938c42762a\">polyposis</span> <strong>(Option A)</strong></li>\n<li>Characteristic CT findings</li>\n<li>Eosinophilic <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> without fungal invasion <strong>(Option B)</strong></li>\n<li>Positive fungal <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> <strong>(Option D)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asthma</li>\n<li>Unilateral disease</li>\n<li>Radiological bone erosion</li>\n<li>Fungal cultures <strong>(Option C)</strong></li>\n<li>Serum eosinophilia</li>\n<li>Charcot-Leyden crystals</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/MeKVTiaXkovdE3pV9L0J1746637504.mp3", "video": ""}, {"text": "A 45-year-old patient presents with symptoms such as a persistent headache and pain in the forehead region, indicating possible frontal sinusitis. Which imaging view is most suitable for evaluating the frontal sinuses in this situation?", "options": [{"label": "A", "text": "Caldwell’s view", "correct": true}, {"label": "B", "text": "Water’s view", "correct": false}, {"label": "C", "text": "Lateral view", "correct": false}, {"label": "D", "text": "Basal view", "correct": false}], "correct_answer": "A. Caldwell’s view", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4S04SSYgX0tj3ITJH5xE1738730010.png", "https://image.prepladder.com/content/3N4P6YRb8IUwhnY3OXVf1738730026.png", "https://image.prepladder.com/content/CDfZRGy5WWEITd4Qmv2k1738730073.png", "https://image.prepladder.com/content/xgyQsLEz5Mj3UUxVhkbV1738730127.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>X-Ray View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structures Seen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Waters’ View (Occipitomental View or Nose-Chin Position):</strong></p>\n<p><strong>(Option B)</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"799\" src=\"https://image.prepladder.com/content/4S04SSYgX0tj3ITJH5xE1738730010.png\" width=\"1044\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The patient's nose and chin touch the film while the <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> beam is projected.</li>\n<li>For enhanced visualisation, an open-mouth view is preferred to display the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <strong>(Pierre’s View)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Maxillary Sinuses:</strong> <strong>Best visualised.</strong></li>\n<li>Frontal Sinuses</li>\n<li><strong>Sphenoid Sinus:</strong> Visible if the mouth is open <strong>(Pierre’s View)</strong></li>\n<li>Zygoma &amp; <span class=\"customMeta\" data-dictid=\"cfb2ffbd2616927772021c3bd61344\">Zygomatic</span> Arch</li>\n<li>Nasal Bone</li>\n<li>Frontal Process of Maxilla</li>\n<li>Superior <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> Fissure</li>\n<li>Infratemporal Fossa</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caldwell View (Occipitofrontal View or Nose-Forehead Position):</strong></p>\n<img alt=\"\" data-author=\"Matt A. Morgan\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/caldwell-view/\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/3N4P6YRb8IUwhnY3OXVf1738730026.png\" width=\"3337\"/><br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The patient’s nose and forehead touch the film &amp; <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> beam projected 15-20° caudally.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Frontal Sinuses:</strong><strong> Best visualised.</strong></li>\n<li>Ethmoid Sinuses</li>\n<li>Maxillary Sinuses</li>\n<li>Frontal Process of Zygoma</li>\n<li>Zygomatic Process of <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">Frontal</span> Bone</li>\n<li>Superior Margin of Orbit and <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">Lamina</span> Papyracea</li>\n<li>Superior <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> Fissure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral View:</strong></p>\n<p><strong>(Option C)</strong></p>\n<img alt=\"\" data-author=\"Own work - Sbks medicos\" data-hash=\"\" data-license=\"CC0 1.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Chevallet_fracture_-_x-ray_lateral_view_of_skull_and_neck.jpg\" data-tags=\"\" height=\"2212\" src=\"https://image.prepladder.com/content/CDfZRGy5WWEITd4Qmv2k1738730073.png\" width=\"4167\"/><br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> side of the skull is against the film with the <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> beam projected perpendicular from the other side.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sphenoid Sinus:</strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> extent.</li>\n<li>Frontal <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">Sinus</span> (highest <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> on <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> view)</li>\n<li>Maxillary Sinus</li>\n<li>Sella Turcica</li>\n<li>Zygoma and <span class=\"customMeta\" data-dictid=\"cfb2ffbd2616927772021c3bd61344\">Zygomatic</span> Arch</li>\n<li><strong>Mandible:</strong> Including <span class=\"customMeta\" data-dictid=\"2d0cdf9e0e1692777185d4b709e843\">coronoid</span> and <span class=\"customMeta\" data-dictid=\"0b59f8cc4b1692777184f80c2ac236\">condyloid</span> processes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Submentovertical (Basal) View: </strong></p>\n<p><strong>(Option D)</strong></p>\n<p><img alt=\"\" data-author=\"Gupta, Deepak &amp; Garg, Preeti &amp; Mittal, Amit.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Submentovertex-view-revealing-expansion-of-the-right-side-of-the-craniofacial-structures_fig8_318486241\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/xgyQsLEz5Mj3UUxVhkbV1738730127.png\" width=\"3117\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> beam is projected from below the chin towards the top of the head.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sphenoid Sinus</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">Ethmoid</span> Sinuses</li>\n<li>Maxillary Sinuses</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hfwtlkPO7FBSV0lL86kC1746636498.mp3", "video": ""}, {"text": "A patient who underwent Functional Endoscopic Sinus Surgery (FESS) presents with persistent nasal discharge and facial pain. During the follow-up, the surgeon considers various potential complications. Which of the following is not a common complication of FESS?", "options": [{"label": "A", "text": "Orbital injury", "correct": false}, {"label": "B", "text": "Optic nerve injury", "correct": false}, {"label": "C", "text": "CSF leak", "correct": false}, {"label": "D", "text": "Fractured nasal bones", "correct": true}], "correct_answer": "D. Fractured nasal bones", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2bcBcfwfsspMsWX6lb7V1738729936.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:661px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is often associated with injury to the<strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> </strong>or excessive <span class=\"customMeta\" data-dictid=\"304afb8f3a16927771928002409199\">middle turbinate</span> resection.</li>\n<li>Control <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> with vasoconstrictors or <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> diathermy; manage severe cases with <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> hemostats or direct repair.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orbital Injury </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>First <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> or during middle meatal antrostomy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orbital <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">Hematoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with injury to the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> artery</li>\n<li>Risk if <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> fat is exposed; requires immediate management.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Nerve Injury</strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible from intra-orbital <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or direct damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF Leak </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Risk around the vertical <span class=\"customMeta\" data-dictid=\"d04c7366b51692777191185d837e24\">lamella</span> of the <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate.</li>\n<li>Immediate repair is usually effective, using fat plugs, artificial materials, or <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> glue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carotid <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is rare but catastrophic, especially during <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> surgery.</li>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"7414bd02f216927771889b3e159ef4\">hemostatic</span> <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> and <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> are essential; consider <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> stenting as an alternative to direct repair.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post Surgery Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Synechiae Formation:</strong> Prevented by <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> with <strong>Mitomycin C</strong> in the middle meatal area.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PDnXGccSm94vlU64WMks1745264267.mp3", "video": ""}, {"text": "A 45-year-old patient presents with symptoms of sinusitis, including nasal obstruction, facial pain, and thick nasal discharge, persisting for the past 6 months. The patient has failed to respond to a course of antibiotics and nasal corticosteroids. What is the step in management to evaluate the extent of sinus involvement ?", "options": [{"label": "A", "text": "Non-Contrast CT", "correct": true}, {"label": "B", "text": "Contrast-Enhanced CT", "correct": false}, {"label": "C", "text": "X-ray", "correct": false}, {"label": "D", "text": "HRCT", "correct": false}], "correct_answer": "A. Non-Contrast CT", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CVqVCyHbiOzkQMYVLqGB1738729873.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rTV5VbbB551sL9QLKcKc1745264191.mp3", "video": ""}, {"text": "A 32-year-old patient with acute sinusitis has had worsening symptoms for ten days. The patient has moderate fever, facial pain, and purulent nasal discharge. What is the most appropriate initial management?", "options": [{"label": "A", "text": "Oral Amoxicillin with clavulanic acid", "correct": true}, {"label": "B", "text": "Intranasal corticosteroids", "correct": false}, {"label": "C", "text": "Topical nasal decongestants", "correct": false}, {"label": "D", "text": "Intravenous antibiotics", "correct": false}], "correct_answer": "A. Oral Amoxicillin with clavulanic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Sinusitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-line:</strong> Oral <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">Amoxicillin</span> with clavulanic acid</p>\n<p><strong>Alternatives:</strong> Doxycycline, Levofloxacin</p>\n<p><strong>Duration:</strong> Typically 7-14 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent symptoms lasting &gt;7-10 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intranasal Corticosteroids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluticasone, Mometasone</p>\n<p>(Reduces mucosal <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and improves <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> drainage)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adjunctive therapy</li>\n<li>Significant mucosal swelling</li>\n<li>Concurrent allergic rhinitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Saline Irrigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps in thinning <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> and flushing bacteria.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptomatic relief and improves <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> clearance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Topical <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Decongestants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxymetazoline, Xylometazoline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Provides <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief.</li>\n<li>Short-term use only and avoid prolonged use to prevent <span class=\"customMeta\" data-dictid=\"a4812dcf9b169277719756aaf48b7c\">rebound</span> congestion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Intervention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> surgery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>For chronic or complicated sinusitis</li>\n<li>Severe cases unresponsive to medical therapy</li>\n<li>Complications such as <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> cellulitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wBdFBD54H58IqRxi7iuA1745264089.mp3", "video": ""}, {"text": "A 32-year-old patient presents with complaints of retro-orbital pain and occasional visual disturbances. CT imaging of the sinuses reveals a posterior ethmoid air cell extending superiorly and laterally to the sphenoid sinus, impinging on the optic nerve. What is the most likely anatomical variant responsible for these symptoms?", "options": [{"label": "A", "text": "Onodi cell", "correct": true}, {"label": "B", "text": "Agger Nasi cell", "correct": false}, {"label": "C", "text": "Haller cell", "correct": false}, {"label": "D", "text": "Frontal recess cell", "correct": false}], "correct_answer": "A. Onodi cell", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VkDatGFBRrfvYZHEjuhp1738729706.png", "https://image.prepladder.com/content/HmuZIzTyhUtwinPnnLOw1738729746.png", "https://image.prepladder.com/content/Gaw397Ixtf6CSErRLvIS1738729787.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:709px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinus Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Agger Nasi Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> cell, located above the <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> and below the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often involved in <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> issues.</p>\n<img alt=\"\" data-author=\"J. JacobsB. ShpiznerE. BrunnerR. LebowitzR. Holliday\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Role-of-the-Agger-Nasi-Cell-in-Chronic-Frontal-Jacobs-Shpizner/968c40d9c84e7052f78911ca6cfa16577e43ce16/figure/4\" data-tags=\"\" height=\"155\" src=\"https://image.prepladder.com/content/VkDatGFBRrfvYZHEjuhp1738729706.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onodi Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> cell extending superiorly and laterally towards the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> sinus, near the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve</p>\n<p>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It may cause retro-orbital pain and visual disturbances due to proximity to the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve.</p>\n<img alt=\"\" data-author=\"Hellerhoff,\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Onodi-Zelle_links_83M_-_CT_axial_und_coronar_-_001_-_Annotation.jpg\" data-tags=\"\" height=\"312\" src=\"https://image.prepladder.com/content/HmuZIzTyhUtwinPnnLOw1738729746.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Haller Cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infraorbital <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> cells extending into the floor of the orbit.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can obstruct the <span class=\"customMeta\" data-dictid=\"99b9c745241692777192ef399e5eae\">maxillary sinus</span> ostium, leading to <span class=\"customMeta\" data-dictid=\"abc34e946e1692777192a0959897ee\">maxillary sinusitis</span> and occasionally <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> symptoms.</p>\n<img alt=\"\" data-author=\"EBq\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://de.wikipedia.org/wiki/Hallersche_Zelle#/media/Datei:Haller_cell_ct.JPG\" data-tags=\"\" height=\"329\" src=\"https://image.prepladder.com/content/Gaw397Ixtf6CSErRLvIS1738729787.png\" width=\"500\"/><br/>\n<br/>\n<br/>\n\t\t\t </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frontal <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">Recess</span> Cell</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Located in the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> area.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It can affect <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> drainage.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tiUkzDqOldT7OYASvERq1745263960.mp3", "video": ""}, {"text": "A 45-year-old patient presents with complaints of a dull headache, post-nasal drip, and retro-orbital pain. On nasal endoscopy, pus is noted draining from the superior meatus. What type of sinusitis is most likely indicated?", "options": [{"label": "A", "text": "Maxillary sinusitis", "correct": false}, {"label": "B", "text": "Anterior ethmoid sinusitis", "correct": false}, {"label": "C", "text": "Posterior ethmoid sinusitis", "correct": true}, {"label": "D", "text": "Frontal sinusitis", "correct": false}], "correct_answer": "C. Posterior ethmoid sinusitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GpgP8X3PCQfzlimblyTr1738729644.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinus Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drainage </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> sinusitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior meatus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Retro-orbital pain, headache</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sphenoid sinusitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenoethmoidal recess</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occipital headache, generalised <span class=\"customMeta\" data-dictid=\"68d37494591692777186d7c7ce4531\">dull</span> headache</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> sinusitis</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Middle meatus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain between eyes, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> congestion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maxillary sinusitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cheek pain, toothache</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frontal sinusitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontal headache, forehead tenderness</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0TEznZ8kglCT4bhaXd8j1745263877.mp3", "video": ""}, {"text": "A 35-year-old patient presents with facial pain, nasal congestion, and purulent nasal discharge for the past 12 days. Examination reveals tenderness over the maxillary sinuses and fever of 38°C. Which of the following is considered a major criterion for diagnosing acute sinusitis?", "options": [{"label": "A", "text": "Facial pain", "correct": true}, {"label": "B", "text": "cough", "correct": false}, {"label": "C", "text": "Headache", "correct": false}, {"label": "D", "text": "Dental pain", "correct": false}], "correct_answer": "A. Facial pain", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:482px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Major Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Minor Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Facial pain/pressure</li>\n<li>Nasal obstruction/congestion</li>\n<li>Purulent <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge</li>\n<li>Hyposmia/Anosmia</li>\n<li>Fever</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li>Dental pain</li>\n<li>Ear fullness</li>\n<li>Cough</li>\n<li>Halitosis (bad breath)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RgIP4QsWtMRQUh6E7fkN1745263798.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 32 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 15 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 55-year-old patient presents with recurrent bleeding. Diagnostic imaging reveals that the bleeding is from the posterior nasal cavity. Which artery, derived from the maxillary artery, is most likely responsible for this condition?", "options": [{"label": "A", "text": "Anterior ethmoidal artery", "correct": false}, {"label": "B", "text": "Posterior ethmoidal artery", "correct": false}, {"label": "C", "text": "Sphenopalatine artery", "correct": true}, {"label": "D", "text": "Superior labial artery", "correct": false}], "correct_answer": "C. Sphenopalatine artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/j2b1X848bfgYSdQMWhmc1738733081.png", "https://image.prepladder.com/content/GOMRqmHF0tknLD005KDj1738733129.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bjlkzE3pwADVz6eALtTj1746001727.mp3", "video": ""}, {"text": "A 35-year-old patient presents with frequent episodes of anterior epistaxis, which are mild and self-limiting. Examination reveals the bleeding site to be in the anteroinferior part of the nasal septum. Which vascular network is most likely involved in this case?", "options": [{"label": "A", "text": "Kiesselbach’s plexus", "correct": true}, {"label": "B", "text": "Woodruff’s plexus", "correct": false}, {"label": "C", "text": "Pterygoid plexus", "correct": false}, {"label": "D", "text": "Cavernous sinus plexus", "correct": false}], "correct_answer": "A. Kiesselbach’s plexus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gtOxxBH8owd9tm2KPvgL1738733220.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:541px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Branch of</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenopalatine artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maxillary artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ophthalmic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (from internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Greater <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maxillary artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">labial</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (from external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/e2XBTb9k1fZeKQQ5LZwj1746004033.mp3", "video": ""}, {"text": "A 28-year-old patient presents with recurrent episodes of mild anterior epistaxis, mainly from the nasal septum. Upon examination, the source of the bleeding is traced to a venous structure near the anterior septum. Which of the following veins is most likely responsible for the bleeding?", "options": [{"label": "A", "text": "Greater palatine vein", "correct": false}, {"label": "B", "text": "Sphenopalatine vein", "correct": false}, {"label": "C", "text": "Retrocolumellar vein", "correct": true}, {"label": "D", "text": "Superior ophthalmic vein", "correct": false}], "correct_answer": "C. Retrocolumellar vein", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VNbVu83wXBdZtszGKXYv1738733262.png", "https://image.prepladder.com/content/DAmb85B3mlD4evzBa2Qo1738733290.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/vMNXjU2LJ5bGugeTXx4G1746004149.mp3", "video": ""}, {"text": "A 65-year-old male with hypertension presents with profuse nasal bleeding from the posterior part of the nasal cavity, unresponsive to pinching and anterior packing. Nasal endoscopy shows bleeding behind the middle turbinate. What is the likely source of bleeding and appropriate management?", "options": [{"label": "A", "text": "Greater palatine artery, Cauterization", "correct": false}, {"label": "B", "text": "Kiesselbach's plexus, Posterior nasal packing", "correct": false}, {"label": "C", "text": "Sphenopalatine artery, Endoscopic intervention", "correct": true}, {"label": "D", "text": "Posterior ethmoidal artery, Endoscopic intervention", "correct": false}], "correct_answer": "C. Sphenopalatine artery, Endoscopic intervention", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anterior Epistaxis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Posterior Epistaxis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding from the front of the nose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bleeding that flows backwards into the throat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Source of bleeding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kiesselbach's plexus</strong><br/>\n\t\t\t(Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> artery, Septal branch of Superior <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">labial</span> artery, Septal branch of <span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\">Sphenopalatine</span> artery, Greater <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Sphenopalatine <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (Most common)</strong></li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> artery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Little's area (anteroinferior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior or superior parts of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> (e.g.Woodruff's plexus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mostly in children and young adults</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More common in adults over 40 years old</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Usual Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trauma (e.g., nose picking, injury)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spontaneous, often associated with <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and arteriosclerosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Local pressure and conservative measures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Postnasal pack, more aggressive treatment often required</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oC0GJJ4H3klGNz2sBFxo1746004299.mp3", "video": ""}, {"text": "A 10-year-old boy presents with recurrent episodes of mild epistaxis. On examination, the bleeding site is found in the anteroinferior part of the nasal septum. What could be the most common cause of epistaxis in this patient?", "options": [{"label": "A", "text": "Hypertension", "correct": false}, {"label": "B", "text": "Nasal trauma", "correct": true}, {"label": "C", "text": "Hereditary hemorrhagic telangiectasia", "correct": false}, {"label": "D", "text": "Coagulation disorder", "correct": false}], "correct_answer": "B. Nasal trauma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes and Common Sites of <span class=\"customMeta\" data-dictid=\"26bb4e3cc81692777187ce44e530e5\">Epistaxis</span> in Different Age Groups</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most Common Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most Common Site</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Children/Young Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nasal trauma (nose-picking)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kiesselbach's <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> (anterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Older Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypertension</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Woodruff’s <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> (posterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>All Ages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infections or dryness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kiesselbach's <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> (anterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hereditary Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hereditary hemorrhagic telangiectasia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple sites in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/B7sDdoPCr1H0v0D7d48K1746008050.mp3", "video": ""}, {"text": "A 30-year-old patient presents with anterior epistaxis after sustaining a nose injury. Despite initial first aid measures, bleeding continues, and a bleeding point is identified. What is the most appropriate next step if the bleeding persists?", "options": [{"label": "A", "text": "Anterior nasal packing", "correct": false}, {"label": "B", "text": "Cauterize with silver nitrate", "correct": true}, {"label": "C", "text": "Embolization", "correct": false}, {"label": "D", "text": "TESPAL", "correct": false}], "correct_answer": "B. Cauterize with silver nitrate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First Line:</strong></p>\n<p><strong>(Direct therapy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>First Aid:</strong>\n<ul>\n<li><strong>Hippocrates method</strong>: <span class=\"customMeta\" data-dictid=\"b6b1ecba7c16927771953ee3dc08ea\">Pinch</span> the nose with the thumb and <span class=\"customMeta\" data-dictid=\"6ee643d13c1692777190386314a416\">index finger</span> for about 5 minutes to control bleeding, especially from Little’s area.</li>\n<li><strong>Trotter’s Method</strong>: Have the patient sit forward over a basin to spit blood and breathe through the mouth. Apply cold compresses to induce vasoconstriction.</li>\n</ul>\n</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Cauterization:</strong>\n<ul>\n<li><strong>Indication</strong>: Effective for <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"26bb4e3cc81692777187ce44e530e5\">epistaxis</span> when the<strong> <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> point is identified</strong>.</li>\n<li>Apply <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> anaesthesia and <strong>cauterize with silver <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> or electrocautery.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Second Line: (Indirect therapy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Anterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Packing: </strong>Clear the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> of blood clots, localise the <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> site, and pack with ribbon <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> soaked in liquid paraffin. The <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> may need to stay for 24-72 hours with <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> antibiotics to prevent infection.</li>\n</ul>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Posterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Packing:</strong>\n<ul>\n<li>Use a cone-shaped <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> pack and a rubber <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> balloon. The pack is guided into the nasopharynx, with an <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> pack to stabilize.</li>\n<li>Patients need to be hospitalised &amp; balloons with separate bulbs for the <span class=\"customMeta\" data-dictid=\"785b6d19ba16927771965c071acb28\">postnasal</span> space and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> are used.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Third Line:</strong></p>\n<p><strong>(Surgical Interventions</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<ul>\n<li><strong>Ligation of Vessels</strong>:\n\t\t\t\t<ul>\n<li><strong>Maxillary Artery</strong>: <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">Ligation</span> via <span class=\"customMeta\" data-dictid=\"7d9662f42016927771835f50649db4\">Caldwell-Luc operation</span> for uncontrollable <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> epistaxis.</li>\n<li><strong>Ethmoidal Arteries</strong>: for <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from above the middle turbinate.</li>\n<li><strong>External Carotid</strong>: <span class=\"customMeta\" data-dictid=\"4d8122357e1692777191499a8b5d79\">Ligate</span> above the superior <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> for persistent <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from the external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> system.</li>\n</ul>\n</li>\n<li><strong>Transnasal <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">Endoscopic</span> <span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\">Sphenopalatine</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">Ligation</span> (TESPAL)</strong>: Locate and <span class=\"customMeta\" data-dictid=\"4d8122357e1692777191499a8b5d79\">ligate</span> the<strong> <span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\">Sphenopalatine</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> </strong><strong>(Artery of Epistaxis) </strong>to control <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> bleeding. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fourth Line (Embolization</strong>)</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Performed by an interventional <span class=\"customMeta\" data-dictid=\"a12be0e0781692777197de201cf697\">radiologist</span> through <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> catheterisation using <span class=\"customMeta\" data-dictid=\"330e2bf7d216927771804326d05181\">absorbable</span> <span class=\"customMeta\" data-dictid=\"b0bdc3a1d416927771884d50c944ec\">gel</span> <span class=\"customMeta\" data-dictid=\"40d72689211692777203fca86e25c9\">foam</span> or coils. It may require <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> embolisation for <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/u6IcTvMkSpIi2JhIKwj01746007919.mp3", "video": ""}, {"text": "Which of the following incisions is most appropriate when ligating the anterior ethmoidal artery to control anterior epistaxis?", "options": [{"label": "A", "text": "Lynch-Howarth incision", "correct": true}, {"label": "B", "text": "Sublabial incision", "correct": false}, {"label": "C", "text": "Gullwing incision", "correct": false}, {"label": "D", "text": "Weber-Ferguson incision", "correct": false}], "correct_answer": "A. Lynch-Howarth incision", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pfKAsGrm6P49wgxcqjmJ1738733354.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BKHW8c5qmMfHcvH9RLCq1746007758.mp3", "video": ""}, {"text": "A 45-year-old patient with Hereditary Hemorrhagic Telangiectasia presents with recurrent epistaxis despite conservative measures. Which of the following treatments is considered the last resort for severe, persistent bleeding that has not responded?", "options": [{"label": "A", "text": "Septal Dermoplasty", "correct": false}, {"label": "B", "text": "Nasal Packing", "correct": false}, {"label": "C", "text": "Nd Laser Therapy", "correct": false}, {"label": "D", "text": "Young's Operation", "correct": true}], "correct_answer": "D. Young's Operation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/BHJVBGfGDD6UNO8X6xqG1746007192.mp3", "video": ""}, {"text": "Match the following types of fractures with respective findings. Type of Fracture Finding 1. Jarjavay Fracture a) 2. Class III Nasal Fracture b) 3. Chevallet Fracture c)", "options": [{"label": "A", "text": "1-c, 2-b, 3-a", "correct": false}, {"label": "B", "text": "1-a, 2-c, 3-b", "correct": false}, {"label": "C", "text": "1-b, 2-a, 3-c", "correct": true}, {"label": "D", "text": "1-a, 2-b, 3-c", "correct": false}], "correct_answer": "C. 1-b, 2-a, 3-c", "question_images": ["https://image.prepladder.com/content/mDWUcqzNGLp1DEK6dW8h1738733414.png", "https://image.prepladder.com/content/tBSoq7XVhkyHZ0pAoySO1738733464.png", "https://image.prepladder.com/content/FtUk0GkOXC2h1I1CfWJQ1738733446.png"], "explanation_images": ["https://image.prepladder.com/content/J84lviRNc3fG9FdvibpO1738733531.png", "https://image.prepladder.com/content/oAYczSEE80p3WmEmbDsz1738733509.png", "https://image.prepladder.com/content/wes9yDnrN8lnO0Mtm71b1738733551.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Class I (Chevallet Fracture)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Class II (Jarjavay Fracture)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Class III (Naso-orbito-ethmoid fracture)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blows from below</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impacts directed from the front</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-velocity trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fracture Line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertical fracture</strong> from the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> spine upwards to the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of the bony and <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the nose.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Horizontal <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> </strong>starting just above the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> spine, running backwards just above the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of septal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and vomer.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves external buttresses of the nose and <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> labyrinth.</p>\n<p><strong>Pig-like appearance </strong>with foreshortened, saddled nose.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Relations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assess for <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and deformity.</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> might only develop later, especially in children.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Check for <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> greater than half the <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> of the nose, which may indicate a septal fracture.</li>\n<li>Requires reduction of both <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> and septal fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Look for signs of more severe injuries, such as <strong>CSF leaks</strong>, multiple <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> tears, and potential cerebral herniation.</li>\n<li>Evaluate for <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> and skull base involvement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4168\" src=\"https://image.prepladder.com/content/J84lviRNc3fG9FdvibpO1738733531.png\" width=\"4168\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4167\" src=\"https://image.prepladder.com/content/oAYczSEE80p3WmEmbDsz1738733509.png\" width=\"4167\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"4168\" src=\"https://image.prepladder.com/content/wes9yDnrN8lnO0Mtm71b1738733551.png\" width=\"4168\"/></td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cHJOGhOOUW3ew22DTIFe1746007487.mp3", "video": ""}, {"text": "A 30-year-old patient presents with a nasal fracture from a frontal blow during a sports accident. The nasal bridge is deviated with swelling and bruising. The patient reports nasal obstruction, but no other facial fractures are noted. What is the most appropriate management approach?", "options": [{"label": "A", "text": "Immediate closed reduction", "correct": false}, {"label": "B", "text": "Open reduction after oedema subsides", "correct": false}, {"label": "C", "text": "Closed reduction after oedema subsides", "correct": true}, {"label": "D", "text": "Nasal packing and observation", "correct": false}], "correct_answer": "C. Closed reduction after oedema subsides", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Physical Examination</strong> is the best method for diagnosing <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> fractures. Look for signs such as swelling, <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> ecchymosis, tenderness, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> deformity, crepitus, epistaxis, and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction.</li>\n<li><strong>X-rays</strong>: These may not always reveal fractures. Necessary views include Waters’ view, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> views, and <span class=\"customMeta\" data-dictid=\"c280cd27f016927771949b7692ab19\">occlusal</span> view.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Simple Fractures</strong>: Generally, no treatment is required if there's no displacement. Monitor for natural healing.</li>\n<li><strong>Closed Reduction</strong>:\n\t\t\t\t<ul>\n<li><strong>Timing</strong>: Ideally performed <strong>before significant <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> develops or after it subsides (Option C)</strong><strong> </strong>(usually 5-7 days).</li>\n<li><strong>Technique</strong>:\n\t\t\t\t\t<ul>\n<li>Use a straight <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> elevator guided by digital <span class=\"customMeta\" data-dictid=\"fb84ef68cf1692777191f6e12eeebe\">manipulation</span> from outside for depressed fractures.</li>\n<li>Reduce laterally displaced <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bridge with firm digital pressure in the opposite direction.</li>\n<li>Disimpaction of <span class=\"customMeta\" data-dictid=\"ab375457da16927771891fcf9431da\">impacted</span> fragments requires Walsham or Asch’s forceps.</li>\n<li>Septal fractures and hematomas should be managed with Asch’s forceps.</li>\n</ul>\n</li>\n<li><strong>Packing</strong>: Unstable fractures require <span class=\"customMeta\" data-dictid=\"7ce016ff5116927771905364aaefee\">intranasal</span> <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> and external splintage.</li>\n</ul>\n</li>\n<li><strong>Open Reduction </strong><strong>(Option B): </strong>Rarely required early &amp; <strong>Considered if closed methods fail, for certain septal injuries &amp; if a patient presents late.</strong></li>\n<li><strong>Correction of Deformities</strong>: May need <span class=\"customMeta\" data-dictid=\"459a2e3696169277719723705213d4\">rhinoplasty</span> or <span class=\"customMeta\" data-dictid=\"246097803f16927771988a4e50cc52\">septorhinoplasty</span> for healed deformities from trauma.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/OW0JpVOy5Ohasy7bnZIH1746006219.mp3", "video": ""}, {"text": "During a closed reduction procedure for a nasal septum, the surgeon selected a forceps, as depicted in the image, and asked the intern to identify it. What is the name of these forceps?", "options": [{"label": "A", "text": "Tilley’s forceps", "correct": false}, {"label": "B", "text": "Walsham’s forceps", "correct": false}, {"label": "C", "text": "Hartmann’s forceps", "correct": false}, {"label": "D", "text": "Asch’s forceps", "correct": true}], "correct_answer": "D. Asch’s forceps", "question_images": ["https://image.prepladder.com/content/X6VLAyQYXbu4AKrFJaOu1738733862.png"], "explanation_images": ["https://image.prepladder.com/content/8JXR9cbJ1aCNz2jiNSSr1738733770.png", "https://image.prepladder.com/content/2QIs4o9aiaYV8OqV8BJz1738733809.png", "https://image.prepladder.com/content/hEghH1hkCz8JBPNngHTv1738733922.png", "https://image.prepladder.com/content/AaKoKpwoImdcKcRwjYpk1738733971.png", "https://image.prepladder.com/content/QNY5LP5AkuQ1MbfRUS8f1738734015.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/848165.mp3", "video": ""}, {"text": "A 32-year-old female involved in a car accident presents to the emergency department with a hanging palate and hanging teeth after her face collided with the dashboard. All of the following are true regarding this type of fracture, except:", "options": [{"label": "A", "text": "Guerin’s sign is present.", "correct": false}, {"label": "B", "text": "Referred to as a transverse maxillary fracture", "correct": false}, {"label": "C", "text": "High risk of CSF rhinorrhea", "correct": true}, {"label": "D", "text": "Fracture line traverses the nasal and maxillary sinus floors", "correct": false}], "correct_answer": "C. High risk of CSF rhinorrhea", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cVaH0UHjQITfqkRJ37R21738734064.png", "https://image.prepladder.com/content/0lo3L1EF20AxUsOJNdJF1738734131.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/KLAwmgtLpHdQJJf8PR1t1746005876.mp3", "video": ""}, {"text": "A 45-year-old male presents with severe facial pain, swelling, and trouble closing his mouth after a high-impact fall. Examination shows a hanging maxilla. What type of fracture does this indicate?", "options": [{"label": "A", "text": "Le fort type I fracture", "correct": false}, {"label": "B", "text": "Le Fort type II fracture", "correct": true}, {"label": "C", "text": "Le Fort type IIIfracture", "correct": false}, {"label": "D", "text": "Tripod fracture", "correct": false}], "correct_answer": "B. Le Fort type II fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QY3Ek62UkEfdOYJtRfOi1738734187.png", "https://image.prepladder.com/content/omketHBTQSVNe0BJrrF21738734216.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:758px\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Le Fort I</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Le Fort II</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Le Fort III</strong></p>\n<p style=\"text-align: center;\"><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Also known as</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Guerin’s <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or Transverse fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyramidal fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Craniofacial disjunction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fracture line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs above and <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the palate, crossing the lower <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, maxillary antra, and <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Passes through the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> root, <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> bone, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> floor, upper maxillary sinus, and <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates</p>\n\t\t\t \n\n\t\t\t<p><strong>Note:</strong> can cause <span class=\"customMeta\" data-dictid=\"6c3d094a46169277719011ea38746a\">infraorbital</span> nerve injury.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Traverses the root of the nose, ethmoid-frontal junction, superior <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> fissure, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> wall, <span class=\"customMeta\" data-dictid=\"65363ac32f16927772030370304d8d\">frontozygomatic</span> and <span class=\"customMeta\" data-dictid=\"fd1ce80ae51692777200b766483942\">temporozygomatic</span> sutures, and the upper <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hanging <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> and hanging <span class=\"customMeta\" data-dictid=\"17dfb015d2169277720023db8fe9e5\">teeth</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hanging maxilla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> bones from the <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> bones</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CSF Rhinorrhea </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk of CSF Rhinorrhea</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zG8VFPGUYDhjn2HQMTzD1746005757.mp3", "video": ""}, {"text": "A 26-year-old male presents with jaw pain, swelling, difficulty opening his mouth, and trouble chewing after being struck in the face during a fight. What is the most common site for mandibular fractures?", "options": [{"label": "A", "text": "Condylar region", "correct": true}, {"label": "B", "text": "Angle of mandible", "correct": false}, {"label": "C", "text": "Symphysis menti", "correct": false}, {"label": "D", "text": "Body of the mandible", "correct": false}], "correct_answer": "A. Condylar region", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/u4u1c9jWxzAoLoWBMagH1738734252.png", "https://image.prepladder.com/content/bywDa3GKX2GKKHvS1uc51738734274.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Ymv7XUlzTjoNwsDi6Jww1746005559.mp3", "video": ""}, {"text": "A 22-year-old woman reports experiencing pain, swelling, blurred vision, and double vision following a facial injury from a basketball. Based on the clinical presentation and radiograph findings, which extraocular muscle is most likely restricted, leading to impaired eye movement?", "options": [{"label": "A", "text": "Inferior rectus", "correct": true}, {"label": "B", "text": "Lateral rectus", "correct": false}, {"label": "C", "text": "Medial rectus", "correct": false}, {"label": "D", "text": "Superior oblique", "correct": false}], "correct_answer": "A. Inferior rectus", "question_images": ["https://image.prepladder.com/content/DAc8YCVTmQJXYRtP3mgY1738734303.png"], "explanation_images": ["https://image.prepladder.com/content/aFE0XxlLwoMAoF8Xphcb1738734362.png", "https://image.prepladder.com/content/MiK3wvgKHw8oaSRejRnv1738734389.png", "https://image.prepladder.com/content/ThAVtSxI3oXT1mmUcQ7T1738734429.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A large <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> object striking the eye globe.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/aFE0XxlLwoMAoF8Xphcb1738734362.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The floor of the orbit.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ecchymosis of the lid, <span class=\"customMeta\" data-dictid=\"d168af6e7f1692777185683fea5e7f\">conjunctiva</span> and sclera.</li>\n<li>Enophthalmos with <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the eyeball.</li>\n<li>Diplopia (displacement of the <span class=\"customMeta\" data-dictid=\"53c6bebcbb169277718777b3fe0e5c\">eyeball</span> or <span class=\"customMeta\" data-dictid=\"025e317c8116927771870f34a94b56\">entrapment</span> of<strong> <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> </strong>and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscles).</li>\n<li>Hypoaesthesia or anaesthesia of the cheek and <span class=\"customMeta\" data-dictid=\"a74788e0671692777201de802ad69f\">upper lip</span> <strong>(infraorbital nerve involvement). </strong></li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> and oedema.</li>\n<li>Restricted eye movement (entrapment of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Forced <span class=\"customMeta\" data-dictid=\"1cbd8c88091692777186c317c24661\">duction</span> test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>To determine if the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle is impinged at the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site.</li>\n<li>A small <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> is used to release the muscle from the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site. Improvement in eye movement suggests muscle impingement.</li>\n</ul>\n<img alt=\"\" data-author=\"Gooris, Peter &amp; Mourits, Maarten &amp; Mensink, Gertjan &amp; Bergsma, Jan. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/AO-illustration-of-forced-duction-test-with-permission-from-AO-Foundation_fig5_376932263\" data-tags=\"\" height=\"601\" src=\"https://image.prepladder.com/content/MiK3wvgKHw8oaSRejRnv1738734389.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X-ray and CT scan shows the characteristic <strong>“teardrop” sign</strong> due to <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> of <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> contents into the maxillary sinus.</p>\n<br/>\n<img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Orbital_blowout_fracture#/media/File:FractLeftOrbitFloorMark.png\" data-tags=\"\" height=\"296\" src=\"https://image.prepladder.com/content/ThAVtSxI3oXT1mmUcQ7T1738734429.png\" width=\"500\"/></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reduction (Indicated if associated with zygomatic/maxillary fractures or significant functional impairment)</li>\n<li>Surgery is required for persistent diplopia, enophthalmos, or muscle entrapment. It typically involves reconstructing the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> floor to correct <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and relieve symptoms.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3kA88xtTYfYrFZYNJp5E1746005415.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 25 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 27 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 7 year old child presents with a unilateral nasal obstruction and a smooth, greyish mass noted on nasal examination. The mass extends posteriorly and is visible in the nasopharynx. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Nasal Dermoid Cyst", "correct": false}, {"label": "B", "text": "Antrochoanal Polyp", "correct": true}, {"label": "C", "text": "Juvenile Nasopharyngeal Angiofibroma", "correct": false}, {"label": "D", "text": "Sinonasal Adenocarcinoma", "correct": false}], "correct_answer": "B. Antrochoanal Polyp", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5ptnFMmzO6TKogmDkKsb1746040011.mp3", "video": ""}, {"text": "A 62-year-old man presents to the ENT clinic with a complaint of persistent nasal obstruction and intermittent epistaxis (nosebleeds) for the past three months. He also reports a sensation of pressure in his right nasal cavity. The patient has a history of smoking and does not have any known allergies. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Nasal polyps", "correct": false}, {"label": "B", "text": "Inverted papilloma", "correct": true}, {"label": "C", "text": "Angiofibroma", "correct": false}, {"label": "D", "text": "Sinonasal adenocarcinoma", "correct": false}], "correct_answer": "B. Inverted papilloma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/e3jnhgog90L45GVz5F151738612827.png", "https://image.prepladder.com/content/uy4ph2Nr4mEEVG7Q4rwe1738612887.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hhtKG0ySBAensXMqIj931746043159.mp3", "video": ""}, {"text": "A 57-year-old man presents to the dermatology clinic with a slowly enlarging, thickened area on his nose that has developed over the past several years. He has a history of rosacea and has noticed increased facial flushing over the past few years. There are no associated symptoms of pain or itching. What is the most likely diagnosis for this patient?", "options": [{"label": "A", "text": "Acne vulgaris", "correct": false}, {"label": "B", "text": "Rhinophyma", "correct": true}, {"label": "C", "text": "Squamous cell carcinoma", "correct": false}, {"label": "D", "text": "Basal cell carcinoma", "correct": false}], "correct_answer": "B. Rhinophyma", "question_images": ["https://image.prepladder.com/content/WbeL8Gm7jI4K2S3Xy4OC1738612613.png"], "explanation_images": ["https://image.prepladder.com/content/wbVd9qz2NQg6dNFoUwpr1738612694.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8cWf3O6jXHymnqzwSyoU1746042994.mp3", "video": ""}, {"text": "Granulomatosis with polyangiitis (GPA) is suspected in a 45-year-old male who presents with chronic sinusitis, hemoptysis, and hematuria. A chest X-ray shows multiple cavitating nodules. Which of the following antibodies is most commonly associated with GPA?", "options": [{"label": "A", "text": "Anti-double-stranded DNA (anti-dsDNA)", "correct": false}, {"label": "B", "text": "Anti-Smith (Anti-Sm)", "correct": false}, {"label": "C", "text": "p-ANCA (perinuclear ANCA)", "correct": false}, {"label": "D", "text": "c-ANCA (cytoplasmic ANCA)", "correct": true}], "correct_answer": "D. c-ANCA (cytoplasmic ANCA)", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ukCUPAoPOJCvWY6XPw2j1746042829.mp3", "video": ""}, {"text": "A 35-year-old male has chronic nasal obstruction, anosmia, and thick nasal crusting with foul-smelling discharge for the past several years. On examination, the following is found.. Culture reveals Klebsiella ozaenae. All of the following options are potential treatment modalities to manage the condition except:", "options": [{"label": "A", "text": "Oestradiol nasal spray", "correct": false}, {"label": "B", "text": "Modified Young's operation", "correct": false}, {"label": "C", "text": "Alkaline nasal douching", "correct": false}, {"label": "D", "text": "Long-term fluoroquinolones", "correct": true}], "correct_answer": "D. Long-term fluoroquinolones", "question_images": ["https://image.prepladder.com/content/bYLVtgm078mkNJODEhVX1738612526.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/A78eAbXKlWb3DWabL0t21746042279.mp3", "video": ""}, {"text": "A 55-year-old woman has a history of progressive nasal congestion, loss of smell, and chronic nasal crusting. Her husband noted a foul smell from her. She has noticed worsening nasal obstruction despite the absence of nasal secretions. On examination, there is evidence of nasal cavity widening with significant crusting and atrophy of the nasal mucosa. Nasal endoscopy shows extensive widespread thinning of the mucosa and bones on turbinates. Which of the following is NOT typically associated with the etiology of her condition?", "options": [{"label": "A", "text": "Klebsiella ozaenae", "correct": false}, {"label": "B", "text": "Industrial irritants", "correct": true}, {"label": "C", "text": "Endocrine disturbances", "correct": false}, {"label": "D", "text": "Autoimmune process", "correct": false}], "correct_answer": "B. Industrial irritants", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/jPerb0roNlEKA9OOoZe61738612454.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Two types of atrophic rhinitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exact cause is not known</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Secondary to infections like syphilis, lupus, leprosy, and rhinoscleroma, <span class=\"customMeta\" data-dictid=\"a75f060aa1169277719777dd69df3f\">radiotherapy</span> to nose, or excessive <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal of turbinates or severely deviated septum.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Theories of primary atrophic rhinitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hereditary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disease involvement in more than one member of the same family.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrine </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Disease usually starts at puberty, involves females more than males, and subsides after menopause.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Racial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>White and yellow races &gt; natives of <span class=\"customMeta\" data-dictid=\"eae58741df1692777187d06ccfb8e9\">equatorial</span> Africa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nutritional deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin A, D, or iron</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infective </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Various organisms have been cultured from cases of atrophic rhinitis.</li>\n<li><strong>Klebsiella ozaenae</strong> is the most common organism. <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autoimmune </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Destructive process to the antigens released from the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> mucosa.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/riiasR4TTJNgCWBilp861746042047.mp3", "video": ""}, {"text": "Which of the following is NOT usually a cause of unilateral nasal polyps?", "options": [{"label": "A", "text": "Antrochoanal polyp", "correct": false}, {"label": "B", "text": "Allergic rhinitis", "correct": true}, {"label": "C", "text": "Chronic bacterial rhinosinusitis", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. Allergic rhinitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qXWOQCRjigDZdmj9eiyc1738612295.png", "https://image.prepladder.com/content/zq6BStVwxGiXAKQhEDI21738612339.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SyrZ9nCXaoh50rGT9vWO1746041617.mp3", "video": ""}, {"text": "Which of the following conditions is least likely to be misdiagnosed as nasal polyps on clinical examination?", "options": [{"label": "A", "text": "Concha bullosa", "correct": false}, {"label": "B", "text": "Meningoencephalocele", "correct": false}, {"label": "C", "text": "Glioma", "correct": false}, {"label": "D", "text": "Rhinoscleroma", "correct": true}], "correct_answer": "D. Rhinoscleroma", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/hbF3pcb3QErcE7v5hyhP1746041414.mp3", "video": ""}, {"text": "A 35-year-old male patient presents with persistent nasal congestion, difficulty breathing, and headaches. Anterior rhinoscopy reveals multiple sessile masses resembling a bunch of grapes, which are insensitive to touch and do not bleed. What is the most appropriate initial step in managing his condition?", "options": [{"label": "A", "text": "Immediate functional endoscopic sinus surgery", "correct": false}, {"label": "B", "text": "Initiation of intranasal steroids", "correct": true}, {"label": "C", "text": "Conducting a saccharin test", "correct": false}, {"label": "D", "text": "Performing a sweat chloride test", "correct": false}], "correct_answer": "B. Initiation of intranasal steroids", "question_images": ["https://image.prepladder.com/content/HMyl2qvdVbed7ls0BEIp1738612019.png", "https://image.prepladder.com/content/K8mWHtDgyymO8PxfD98G1738612077.png"], "explanation_images": ["https://image.prepladder.com/content/B1OxSKkhoJGfP09rCvSH1738612132.png", "https://image.prepladder.com/content/brYfVgo7ngn50p9zq7f01738612180.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PSA5sL0MX02HUuTUbkgz1746041182.mp3", "video": ""}, {"text": "A 35-year-old patient presents with nasal congestion, difficulty breathing, and frequent headaches. Anterior rhinoscopy reveals multiple sessile masses resembling a bunch of grapes, which are insensitive to touch and do not bleed. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Allergic Rhinitis", "correct": false}, {"label": "B", "text": "Ethmoidal Polyp", "correct": true}, {"label": "C", "text": "Nasal Carcinoma", "correct": false}, {"label": "D", "text": "Acute Sinusitis", "correct": false}], "correct_answer": "B. Ethmoidal Polyp", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Xk0aoNzJJxUCmMaOVAtx1738611924.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FcnJ8beyMX3bA1C1BnNr1746040953.mp3", "video": ""}, {"text": "A 32-year-old woman with a history of bronchial asthma and aspirin intolerance presents with worsening nasal congestion, sinus infections, and diminished sense of smell. Nasal polyps are observed on examination. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cystic Fibrosis", "correct": false}, {"label": "B", "text": "Samter’s Triad", "correct": true}, {"label": "C", "text": "Churg-Strauss Syndrome", "correct": false}, {"label": "D", "text": "Kartagener Syndrome", "correct": false}], "correct_answer": "B. Samter’s Triad", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Rhinosinusitis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Seen in both allergic and nonallergic origins of chronic rhinosinusitis.</li>\n<li>Nonallergic <span class=\"customMeta\" data-dictid=\"a8dad7cd171692777197e6d4ac2a1c\">Rhinitis</span> with <span class=\"customMeta\" data-dictid=\"80cb15b2241692777187fa1260c99c\">Eosinophilia</span> Syndrome (NARES) is a specific type of <span class=\"customMeta\" data-dictid=\"10322d88e516927771846e0a64000c\">chronic rhinitis</span> <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> with polyps.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Asthma</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>7% of <span class=\"customMeta\" data-dictid=\"76891bb6e91692777182cda16e1db6\">asthma</span> patients may develop <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> polyps.</li>\n<li>Including both <span class=\"customMeta\" data-dictid=\"afad60190f1692777182663499dc42\">atopic</span> and nonatopic asthma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspirin Intolerance</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>36% of patients with <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> <span class=\"customMeta\" data-dictid=\"7794e5fd7a1692777190ee626ede62\">intolerance</span> may have <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> polyps.</li>\n<li><strong>Samter’s Triad:</strong> Combination of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> polyps, asthma, and <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> intolerance. <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystic Fibrosis</strong><strong> (Option A ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>20% of patients with <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> develop <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> polyps.</li>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> production.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Allergic Fungal Sinusitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Almost all cases present with <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> polyps.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kartagener Syndrome </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes bronchiectasis, sinusitis, <span class=\"customMeta\" data-dictid=\"35a2ef94341692777198d9bf1cd98e\">situs</span> inversus, and <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> dyskinesia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Young Syndrome</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Characterized by <span class=\"customMeta\" data-dictid=\"6266bf3b0b1692777198fdc36807cb\">sinopulmonary</span> disease and azoospermia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Churg-Strauss Syndrome </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Features asthma, fever, eosinophilia, vasculitis, and granuloma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasal Mastocytosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"a8dad7cd171692777197e6d4ac2a1c\">rhinitis</span> with <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cell <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> mucosa.</li>\n<li>Few eosinophils are present; <span class=\"customMeta\" data-dictid=\"aa1288c36b16927771814fa5aa84eb\">allergy</span> skin tests and <span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\">IgE</span> levels are normal.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5YwymwGcUnXusoieahkD1746040825.mp3", "video": ""}, {"text": "Which of the following statements is false regarding ethmoidal polyps?", "options": [{"label": "A", "text": "Ethmoidal polyps often arise from the middle meatus.", "correct": false}, {"label": "B", "text": "Allergic nasal polyps commonly originate from the septum.", "correct": true}, {"label": "C", "text": "Ethmoidal polyps can grow anteriorly and may present at the nares.", "correct": false}, {"label": "D", "text": "A common site for ethmoidal polyp is the uncinate process.", "correct": false}], "correct_answer": "B. Allergic nasal polyps commonly originate from the septum.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:651px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antrochoanal polyp</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ethmoidal polyp</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in children</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in adult</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Number</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Solitary</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Multiple</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laterality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maxillary <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> near the ostium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ethmoidal sinuses, <span class=\"customMeta\" data-dictid=\"304afb8f3a16927771928002409199\">middle turbinate</span> and middle meatus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grows backwards to the choana; may hang down behind the soft palate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mostly grow anteriorly and may present at the nares</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Size and shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trilobed (dumb-bell) with antral, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> and <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> parts.</li>\n<li>Choanal parts may protrude through the <span class=\"customMeta\" data-dictid=\"45dd0607f716927771844e1a52db71\">choana</span> &amp; fill the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> obstructing both sides</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually small and grape-like masses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncommon if removed completely</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The treatment is only surgical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>About 50% of patients respond to <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> therapy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/shguRilTJVTP4NObUTVb1746040655.mp3", "video": ""}, {"text": "A 10-year-old child presents with a history of nasal obstruction predominantly on the right side, mouth breathing, and occasional snoring for the past year. He also has intermittent right-sided nasal discharge and postnasal drip. There is no history of allergies or asthma. A smooth, grayish mass is seen in the right nasal cavity extending into the nasopharynx on rhinoscopic examination. Which among the following is the most appropriate next step in managing his condition?", "options": [{"label": "A", "text": "Perform a non-contrast CT scan and plan for FESS", "correct": true}, {"label": "B", "text": "Intranasal corticosteroids and oral antihistamines.", "correct": false}, {"label": "C", "text": "Plain X-ray and perform a biopsy.", "correct": false}, {"label": "D", "text": "MRI and start empirical antibiotics.", "correct": false}], "correct_answer": "A. Perform a non-contrast CT scan and plan for FESS", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/E200FC4fFtf7UJEsH7ua1738611815.png", "https://image.prepladder.com/content/2Vz1dTGRmCGT7bsDRkzP1738611614.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2WjZ1GaNn1NXuJJB4o4D1746040484.mp3", "video": ""}, {"text": "A 9 y/o child presents with a unilateral nasal obstruction, hyponasality, and a mucoid nasal discharge. Anterior rhinoscopy shows a smooth, greyish mass, but the polyp is not fully visible. What is the most likely finding on posterior rhinoscopy?", "options": [{"label": "A", "text": "A pink and congested mass in the anterior nasal cavity", "correct": false}, {"label": "B", "text": "A globular mass behind the soft palate in the nasopharynx", "correct": true}, {"label": "C", "text": "A firm, non-movable mass in the maxillary antrum", "correct": false}, {"label": "D", "text": "A midline pit with protruding hair in the nasal dorsum", "correct": false}], "correct_answer": "B. A globular mass behind the soft palate in the nasopharynx", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XmmLGUvUpDd14UDxuA381738611469.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Unilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by the polyp's growth into the choana, leading to one-sided <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> blockage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occurs if the <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> is large enough to obstruct both <span class=\"customMeta\" data-dictid=\"caf415be011692777184012e29c4e1\">choanae</span> by protruding into the nasopharynx.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyponasality (Rhinolalia clausa)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Change in voice quality to a \"thick\" or \"dull\" sound due to <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> obstruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasal Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucoid discharge, <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> or <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> depending on the polyp's size and location.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Rhinoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>May miss the <span class=\"customMeta\" data-dictid=\"b5c135c2311692777196832953e406\">polyp</span> if posterior; visible as a smooth, greyish mass with <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge.</li>\n<li>Can be soft and movable, or protrude pink and <span class=\"customMeta\" data-dictid=\"8edfbdf9211692777184ea95263168\">congested</span> from the nostril.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Rhinoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Reveals a <span class=\"customMeta\" data-dictid=\"7fb01b5ad51692777188c3cb1733f9\">globular</span> mass in the nasopharynx, behind the soft palate.</li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> dorsum, maxillary <span class=\"customMeta\" data-dictid=\"96976bc5fc1692777181dc8403015a\">antrum</span> are not visible on <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> rhinoscopy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasal Endoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides detailed view of the polyp’s origin in the maxillary antrum, its three parts, and its extent within the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and nasopharynx.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uc7vwDu3rdhjAf7l3YNh1746040216.mp3", "video": ""}, {"text": "Match the stages of rhinoscleroma with its characteristics features: Stages of rhinoscleroma Characteristic features 1. Atrophic stage a. Stenosis of nares and nasopharynx. 2. Granulomatous stage b. Painless and non-ulcerative nodules. 3. Cicatricial stage c. Foul smelling purulent nasal discharge and crusting. d. Black membrane in the nasal mucosa.", "options": [{"label": "A", "text": "1-c, 2-b, 3-a", "correct": true}, {"label": "B", "text": "1-b, 2-d, 3-b", "correct": false}, {"label": "C", "text": "1-a, 2-c, 3-b", "correct": false}, {"label": "D", "text": "1-d, 2-a, 3-c", "correct": false}], "correct_answer": "A. 1-c, 2-b, 3-a", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/adHe7EkwVbPk37NSUeUt1738610187.png", "https://image.prepladder.com/content/m0dZytEnOLLvUzjGHg3b1738610248.png", "https://image.prepladder.com/content/mDPiXXfGFs7y2xackVfL1738610289.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:589px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stages of rhinoscleroma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Atrophic stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>c. Foul smelling <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> and crusting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">Granulomatous</span> stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>b. Painless and non-ulcerative nodules.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. <span class=\"customMeta\" data-dictid=\"315587fa991692777184026693ef7f\">Cicatricial</span> stage</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>a. <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> of nares and nasopharynx.</p>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/oA1udVwYS2EzA4oKe82x1745346471.mp3", "video": ""}, {"text": "A 5 y/o child presents with a midline pit on the nasal dorsum, with hair protruding from the opening. Imaging reveals a sinus tract leading to a cyst under the nasal bone. What is the most appropriate next step in management?", "options": [{"label": "A", "text": "Observation and monitoring", "correct": false}, {"label": "B", "text": "Topical antibiotic treatment", "correct": false}, {"label": "C", "text": "Surgical excision of the cyst and sinus tract", "correct": true}, {"label": "D", "text": "Corticosteroid injection to reduce the cyst", "correct": false}], "correct_answer": "C. Surgical excision of the cyst and sinus tract", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple Dermoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Midline swellings under the skin, in front of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bones, no external opening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermoids with a Sinus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common in infants/children; midline <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> on <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> dorsum, often with hair protruding from the opening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasal Dermoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present with widening of the upper <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, splaying of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bones, hypertelorism; may have a midline pit with protruding hair.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zqjXpnYQkHd4XJIKclxp1746038302.mp3", "video": ""}, {"text": "A 3 year old child presents with a firm swelling on the bridge of the nose. Imaging reveals that the mass is encapsulated and has no connection to the brain. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Nasal polyp", "correct": false}, {"label": "B", "text": "Encephalocoele", "correct": false}, {"label": "C", "text": "Glioma", "correct": true}, {"label": "D", "text": "Dermoid cyst", "correct": false}], "correct_answer": "C. Glioma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Presentation Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extranasal (60%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Firm, <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> swellings. Common locations: bridge of the nose, side of the nose, near the inner <span class=\"customMeta\" data-dictid=\"f92b3ecaa0169277718358accfad7b\">canthus</span> (corner of the eye).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intranasal (30%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Located entirely within the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combined (10%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Have both <span class=\"customMeta\" data-dictid=\"7ce016ff5116927771905364aaefee\">intranasal</span> and extranasal components.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/mdaC7XOQSr9Ynr4JdbUl1746038090.mp3", "video": ""}, {"text": "A 2 month old infant presents with a pulsatile swelling at the root of the nose that changes size when the infant coughs. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Dermoid cyst", "correct": false}, {"label": "B", "text": "Nasal polyp", "correct": false}, {"label": "C", "text": "Meningoencephalocele", "correct": true}, {"label": "D", "text": "Hemangioma", "correct": false}], "correct_answer": "C. Meningoencephalocele", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:440px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasofrontal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At the root of the nose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasoethmoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Side of the nose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Naso-orbital</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anteromedial aspect of the orbit (eye socket)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pYNnfydU5P7lYgI0kQvp1746037835.mp3", "video": ""}, {"text": "A 6-month-old infant presents with a soft, compressible mass at the root of the nose. The mass increases in size when the baby cries and shows a positive Furstenberg test. What is the most appropriate next step in the management of this condition?", "options": [{"label": "A", "text": "Fine-needle aspiration", "correct": false}, {"label": "B", "text": "Biopsy of the lesion", "correct": false}, {"label": "C", "text": "CT scan", "correct": true}, {"label": "D", "text": "Antibiotics and follow up", "correct": false}], "correct_answer": "C. CT scan", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Meningocele</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Herniation of the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> with the <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> </strong>through a <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the skull base.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by <strong>incomplete <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the bones in the roof of the nose </strong>(frontal bone, <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate of the ethmoid, or sphenoid), leading to <span class=\"customMeta\" data-dictid=\"7133d43878169277718890fcb091d5\">herniation</span> of meninges.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <strong>Suwanwela and Suwanwela <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> </strong>is used to categorize different types of meningo-encephaloceles based on their <strong>location and <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> features.</strong></p>\n<ul>\n<li><strong>Occipital (most common)</strong></li>\n<li>Cranial Vault</li>\n<li>Fronto-Ethmoidal (Sincipital)</li>\n<li>Basal</li>\n<li>Posterior Fossa</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Soft, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> swelling</li>\n<li>Positive compressibility, reducibility, <strong>transillumination and <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> impulse.</strong></li>\n<li><strong>Furstenberg test </strong>- positive(the size of a <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> or <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> mass increases upon applying <strong>pressure to the internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> veins or by valsalva</strong>)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CT and <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> are critical;</li>\n<li><strong>Biopsy</strong> is <strong>contraindicated</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and skull base reconstruction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9hFlcLMwlWeY49T8WZKB1746037617.mp3", "video": ""}, {"text": "A 2-day-old full-term male infant is brought to the emergency room with difficulty breathing, especially when feeding, and cyanosis. The cyanosis improves when the infant cries but worsens when feeding. The baby is in respiratory distress. What is the best initial emergency management for this patient?", "options": [{"label": "A", "text": "Inserting a wide bore feeding nipple into the mouth of the infant", "correct": true}, {"label": "B", "text": "Bag-mask ventilation", "correct": false}, {"label": "C", "text": "Immediate tracheostomy", "correct": false}, {"label": "D", "text": "Endotracheal intubation", "correct": false}], "correct_answer": "A. Inserting a wide bore feeding nipple into the mouth of the infant", "question_images": ["https://image.prepladder.com/content/fmpdoyK1oLn3DKtGS2DG1738611223.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Choanal Atresia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 in 7000 live births.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistence of <strong>nasobuccal <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> of Hochstetter. </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unilateral (more common)</li>\n<li>Bilateral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete</li>\n<li>Incomplete</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bony (30%)</li>\n<li>Membranous</li>\n<li>Mixed (70%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> atresia</strong> (presents during <strong>neonatal period</strong>):</p>\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> (as neonates are <span class=\"customMeta\" data-dictid=\"24aaa040781692777194151ac19d88\">obligate</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> breathers)</li>\n<li>Cyclical <span class=\"customMeta\" data-dictid=\"f3b66d8ec4169277718566066add68\">cyanosis</span> <strong>relieved by crying.</strong></li>\n<li>Cyanosis during feeding.</li>\n</ul>\n<p><strong>Unilateral <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> </strong>(presents <strong>later in life</strong>):</p>\n<ul>\n<li>Failure to pass <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube on that side</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CHARGE syndrome: (due to mutations in the <strong>CHD7 gene on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 8</strong>)</p>\n<ul>\n<li><strong>C</strong>oloboma</li>\n<li><strong>H</strong>eart defects</li>\n<li><strong>A</strong>tresia choanae</li>\n<li><strong>R</strong>etardation of growth</li>\n<li><strong>G</strong>enital anomalies</li>\n<li><strong>E</strong>ar abnormalities</li>\n</ul>\n<p>These abnormalities must be excluded in a child with <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> and therefore the <strong>minimum investigations</strong> in addition to the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> are <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> echo, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> scan, and an <span class=\"customMeta\" data-dictid=\"b0355c2c701692777194797cca9fac\">ophthalmology</span> and <span class=\"customMeta\" data-dictid=\"0374b03e6d16927771825d98e61878\">audiology</span> review.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical:</p>\n<ul>\n<li><strong>Misting test </strong>with a metal <span class=\"customMeta\" data-dictid=\"2cd284701016927771984ff3e4605b\">spatula</span> below <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> aperture.</li>\n<li>Inability to pass a <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube</li>\n</ul>\n<p>Definitive investigations:</p>\n<ul>\n<li>CT scan ( after <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> decongestants)</li>\n<li>Nasal endoscopy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate:</p>\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> placement.</li>\n<li>A wide bore <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> is inserted into the mouth of the infant - <strong>Mc Govern’s technique. </strong><strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definitive: <strong>Surgery </strong>(at 1.5 years of age)</p>\n<ul>\n<li>Endoscopic transnasal approach (most common).</li>\n<li>Transpalatal approach used in complex cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post op <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> and management.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Granulation tissue formation</strong></li>\n<li>Managed with: KTP laser, <strong>Mitomycin C.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YGdaXbj1anxh1a9av2NG1746037342.mp3", "video": ""}, {"text": "A newborn is brought to the clinic with respiratory distress, which worsens during feeding and improves with crying. The baby shows difficulty in passing a nasogastric tube through one nasal passage, and a CT scan reveals a mixed bony and membranous obstruction in the posterior nasal cavity. This condition is due to the persistence of which membrane during development?", "options": [{"label": "A", "text": "Buccopharyngeal membrane", "correct": false}, {"label": "B", "text": "Orobuccal membrane", "correct": false}, {"label": "C", "text": "Nasobuccal membrane", "correct": true}, {"label": "D", "text": "Oropharyngeal membrane", "correct": false}], "correct_answer": "C. Nasobuccal membrane", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Choanal Atresia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1 in 7000 live births.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistence of <strong>nasobuccal <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> of Hochstetter. </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unilateral (more common)</li>\n<li>Bilateral</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete</li>\n<li>Incomplete</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bony &gt; Membranous</li>\n<li>Mixed (70%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bilateral <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> atresia</strong> (presents during <strong>neonatal period</strong>):</p>\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> (as neonates are <span class=\"customMeta\" data-dictid=\"24aaa040781692777194151ac19d88\">obligate</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> breathers)</li>\n<li>Cyclical <span class=\"customMeta\" data-dictid=\"f3b66d8ec4169277718566066add68\">cyanosis</span> <strong>relieved by crying.</strong></li>\n<li>Cyanosis during feeding.</li>\n</ul>\n<p><strong>Unilateral <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> </strong>(presents <strong>later in life</strong>):</p>\n<ul>\n<li>Failure to pass <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube on that side</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CHARGE syndrome: (due to mutations in the <strong>CHD7 gene on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 8</strong>)</p>\n<ul>\n<li><strong>C</strong>oloboma</li>\n<li><strong>H</strong>eart defects</li>\n<li><strong>A</strong>tresia choanae</li>\n<li><strong>R</strong>etardation of growth</li>\n<li><strong>G</strong>enital anomalies</li>\n<li><strong>E</strong>ar abnormalities</li>\n</ul>\n<p>These abnormalities must be excluded in a child with <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> and therefore the <strong>minimum investigations</strong> in addition to the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> are <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> echo, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> scan, and an <span class=\"customMeta\" data-dictid=\"b0355c2c701692777194797cca9fac\">ophthalmology</span> and <span class=\"customMeta\" data-dictid=\"0374b03e6d16927771825d98e61878\">audiology</span> review.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical:</p>\n<ul>\n<li><strong>Misting test </strong>with a metal <span class=\"customMeta\" data-dictid=\"2cd284701016927771984ff3e4605b\">spatula</span> below <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> aperture.</li>\n<li>Inability to pass a <span class=\"customMeta\" data-dictid=\"de300f68ca16927771938f9572d888\">nasogastric</span> tube</li>\n</ul>\n<p>Definitive investigations:</p>\n<ul>\n<li>CT scan ( after <span class=\"customMeta\" data-dictid=\"bdc0a4cb9016927771995488a2b961\">suction</span> and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> decongestants)</li>\n<li>Nasal endoscopy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate:</p>\n<ul>\n<li>Oral <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> placement.</li>\n<li>A wide bore <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> is inserted into the mouth of the infant - <strong>Mc Govern’s technique.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Definitive: <strong>Surgery</strong> (at 1.5 years of age)</p>\n<ul>\n<li>Endoscopic transnasal approach (most common).</li>\n<li>Transpalatal approach used in complex cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-op <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> and management.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Granulation tissue formation and re-stenosis</strong></li>\n<li>Managed with: KTP laser, <strong>Mitomycin C.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/w8Iw1YkeFSf5PpykTAhl1746037131.mp3", "video": ""}, {"text": "A 32-year-old woman presents to the clinic with symptoms of nasal obstruction, crusting, and facial pain that have been worsening over the past few months. She reports persistent nasal congestion and frequent nosebleeds. On physical examination, there is purplish discoloration of the nasal skin and a nasal endoscopy reveals erythematous mucosa covered with pale granulomas, as shown in the image. A biopsy of the nasal lesion reveals non-caseating granulomas. Which of the following is the mainstay of treatment?", "options": [{"label": "A", "text": "Methotrexate", "correct": false}, {"label": "B", "text": "Inhaled corticosteroids", "correct": false}, {"label": "C", "text": "Systemic steroids", "correct": true}, {"label": "D", "text": "Antihistamines", "correct": false}], "correct_answer": "C. Systemic steroids", "question_images": ["https://image.prepladder.com/content/s9rpEDhYfgIpPZhOjfl11738610990.png"], "explanation_images": ["https://image.prepladder.com/content/HoW5fKTnCBbdIRxUnA8e1738611046.png", "https://image.prepladder.com/content/zEtVId8nF0lsp5HrvPNV1738611090.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Granulomatous Conditions of the Nose: Sarcoidosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immune-mediated chronic <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> disease.</li>\n<li>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement is up to 9%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More frequent in women</p>\n<p>Peak age: 30-40 years.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nasal obstruction</li>\n<li>Crusting</li>\n<li><strong>Purplish discoloration - <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> <span class=\"customMeta\" data-dictid=\"131d57aa0c1692777195bec93673c7\">pernio</span> (specific)</strong></li>\n<li>Nasal bleeding</li>\n<li>Facial pain.</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> - <strong>characteristic ‘strawberry’ appearance </strong>of inflamed <strong>erythematous <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> covered with pale granulomas</strong>.</li>\n<li>Anterior septal perforation- usually only involves cartilagenous part.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Non-specific: Elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> ACE, hypercalcemia.</li>\n<li>Kveim test (outdated)</li>\n<li>Imaging: CXR (bilateral hilar lymphadenopathy), CT for sinus/nasal involvement.</li>\n<li>Biopsy: <strong>Non-caseating granulomas. (Confirmatory)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Krespi <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> of sinonasal sarcoidosis</p>\n<ul>\n<li><strong>Stage I</strong>: Mild, <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> (nose only).</li>\n<li><strong>Stage II</strong>: Moderate, <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> (nose + limited sinuses).</li>\n<li><strong>Stage III</strong>: Severe, <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> sinonasal disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic steroids <strong>(Option C)</strong> <strong>(mainstay),</strong> <span class=\"customMeta\" data-dictid=\"a98f8182f116927771927e607ba8c8\">methotrexate</span> (steroid-sparing).</li>\n<li>Topical: <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> steroids, douching, lubricants.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two-thirds remit spontaneously.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/B3GDYkYG4VLDpts99o3t1746036754.mp3", "video": ""}, {"text": "A 45-year-old man presents with a chronic, non-healing lesion on his nasal tip, accompanied by intermittent nasal obstruction. Over the past several months, the lesion has progressively worsened. On examination, the following lesion is seen as shown in the image. A biopsy of the lesion reveals caseating granulomas. What is the treatment of choice for this condition?", "options": [{"label": "A", "text": "Methotrexate", "correct": false}, {"label": "B", "text": "Systemic steroids", "correct": false}, {"label": "C", "text": "Surgical excision", "correct": false}, {"label": "D", "text": "Antitubercular therapy (ATT)", "correct": true}], "correct_answer": "D. Antitubercular therapy (ATT)", "question_images": ["https://image.prepladder.com/notes/8sTt3Q4dP6AzpSxi2tfG1746068233.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Granulomatous Infection of the Nose: Tuberculosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong><em>Mycobacterium tuberculosis</em></strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidemiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually <strong>secondary to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> TB.</strong></p>\n<p>Primary <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> TB accounts for only one-third of cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulcerative form:</p>\n<ul>\n<li>Affects the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> part of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> and the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> end of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> turbinate, causing <strong>perforation</strong>.</li>\n</ul>\n<p>Nodular form: <strong>Lupus vulgaris</strong></p>\n<ul>\n<li>Low-grade <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> TB infection in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> vestibule</li>\n<li>Present as <strong>pale reddish nodules on the <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> or tip of the nose,</strong> which does not blanch on pressure, known as <strong>Apple <span class=\"customMeta\" data-dictid=\"88bc2baef31692777190f5b09925aa\">jelly</span> nodules.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Biopsy <strong>(Gold standard): Caseating <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> granulomas.</strong></li>\n<li>Acid-fast <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> (may be negative)</li>\n<li>Cultures (may be negative)</li>\n<li>Skin testing (e.g., <span class=\"customMeta\" data-dictid=\"0fe92012341692777201bab3db39b1\">tuberculin</span> skin test)</li>\n<li>Serum testing (e.g., QuantiFERON)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Both types of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> TB are treated with combination <strong>antituberculous <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> (ATT).</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RsSpwErt0yHwFJL7jPt81746036043.mp3", "video": ""}, {"text": "A 35-year-old man presents with nasal obstruction, recurrent nasal bleeding, and a mass protruding from his nasal cavity. On examination, a polypoidal, pink-colored mass with white dots on the surface is noted. It bleeds easily on touch. A biopsy is shown below. What is the most appropriate treatment for this patient?", "options": [{"label": "A", "text": "Amphotericin B", "correct": false}, {"label": "B", "text": "Cyclophosphamide", "correct": false}, {"label": "C", "text": "Dapsone", "correct": false}, {"label": "D", "text": "Complete excision of the mass", "correct": true}], "correct_answer": "D. Complete excision of the mass", "question_images": ["https://image.prepladder.com/content/8xNQY9zr8rVGrRfMrWbg1738610752.png"], "explanation_images": ["https://image.prepladder.com/content/iZoTskll3nAx5Wr69xdO1738610810.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZhV9XGoU2M1dSrpzKpjw1746035016.mp3", "video": ""}, {"text": "A 42-year-old man presents with a long-standing history of nasal obstruction, recurrent nasal bleeding, and mass protruding from his nasal cavity. He reports frequent swimming in freshwater ponds. Which of the following findings on clinical examination is most characteristic of rhinosporidiosis?", "options": [{"label": "A", "text": "Polypoidal, pink-colored mass with white dots on the surface", "correct": true}, {"label": "B", "text": "Soft, dark red, pedunculated or sessile mass", "correct": false}, {"label": "C", "text": "Pale polypoidal mass", "correct": false}, {"label": "D", "text": "Firm, rounded, yellowish mass with blood vessels on the surface", "correct": false}], "correct_answer": "A. Polypoidal, pink-colored mass with white dots on the surface", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/AsnsTiMtHfNGmt4shqti1738610663.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WCYMQjXgGIgbzkkGw6ps1746034887.mp3", "video": ""}, {"text": "A 45-year-old woman has a history of progressive nasal obstruction, recurrent nosebleeds, and crusting. On examination, she has a nasal deformity with a firm mass in the nasal cavity. A biopsy of the mass shows Mikulicz cells and is positive for Klebsiella rhinoscleromatis . What is the most appropriate treatment strategy for this patient?", "options": [{"label": "A", "text": "Prolonged course of tetracycline and streptomycin", "correct": true}, {"label": "B", "text": "Amphotericin B", "correct": false}, {"label": "C", "text": "Only Prednisolone without antibiotics", "correct": false}, {"label": "D", "text": "Surgical debridement", "correct": false}], "correct_answer": "A. Prolonged course of tetracycline and streptomycin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/7gt7Kte739NKrB1IiPnD1746032893.mp3", "video": ""}, {"text": "A 35-year-old woman from a rural area has nasal obstruction, crusting, and a history of progressive nasal swelling over the past several months. On examination, nodular masses in the nasal cavity are noted. A biopsy is done and shown below. Which of the following histopathological findings is characteristic of the condition in this patient?", "options": [{"label": "A", "text": "Psammoma Bodies", "correct": false}, {"label": "B", "text": "Mikulicz cells", "correct": true}, {"label": "C", "text": "Aschoff Bodies", "correct": false}, {"label": "D", "text": "Verocay Bodies", "correct": false}], "correct_answer": "B. Mikulicz cells", "question_images": ["https://image.prepladder.com/content/qTPU2ZdS68qZpRJh1TUN1739253671.png", "https://image.prepladder.com/content/3lc4fJwXszRfiZXl0fFv1738610381.png"], "explanation_images": ["https://image.prepladder.com/content/xM4UGb5IWHHtuZop6mln1738610523.png", "https://image.prepladder.com/content/BeHJ2PX6vZhO8phDypBE1738610569.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5idpNvE3t2W8W1XZPTkB1746032637.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 37 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 95 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "In nasopharyngeal carcinoma, which of the following is a component of trotter's triad?", "options": [{"label": "A", "text": "Conductive hearing loss, ipsilateral temporoparietal neuralgia, palatal paralysis", "correct": true}, {"label": "B", "text": "Sensorineural hearing loss, contralateral temporoparietal neuralgia, palatal paralysis", "correct": false}, {"label": "C", "text": "Sensorineural hearing loss, ipsilateral temporoparietal neuralgia, palatal paralysis", "correct": false}, {"label": "D", "text": "Conductive hearing loss, contralateral temporoparietal neuralgia, palatal paralysis", "correct": false}], "correct_answer": "A. Conductive hearing loss, ipsilateral temporoparietal neuralgia, palatal paralysis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient came with complaints of nasal obstruction, loss of smell and foul smelling nasal discharge. On examination, presence of yellowish-green crusts in the nasal cavity along with merciful anosmia is observed. Which of the following additional findings may be observed in this patient?", "options": [{"label": "A", "text": "Roomy nasal cavity", "correct": true}, {"label": "B", "text": "Nasal polyps", "correct": false}, {"label": "C", "text": "Inferior turbinate hypertrophy", "correct": false}, {"label": "D", "text": "Foreign body", "correct": false}], "correct_answer": "A. Roomy nasal cavity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Roomy &lt;span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\"&gt;nasal&lt;/span&gt; cav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not considered a major diagnostic criterion for allergic fungal sinusitis?", "options": [{"label": "A", "text": "Fungal culture", "correct": true}, {"label": "B", "text": "Presence of Allergic Mucin", "correct": false}, {"label": "C", "text": "Characteristic CT findings: Double Density", "correct": false}, {"label": "D", "text": "Positive KOH stain", "correct": false}], "correct_answer": "A. Fungal culture", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Major Criteria (must meet all)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Minor Criteria (supportive)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Type I <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> (history, skin test, or <span class=\"customMeta\" data-dictid=\"16519ed6441692777190f7784d60d8\">in vitro</span> testing)</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"fe6b8df2fa1692777196938c42762a\">polyposis</span> <strong>(Option A)</strong></li>\n<li>Characteristic CT findings <strong>(Option C ruled out)</strong></li>\n<li>Eosinophilic <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> without fungal invasion <strong>(Option B ruled out)</strong></li>\n<li>Positive fungal <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asthma</li>\n<li>Unilateral disease</li>\n<li>Radiological bone erosion</li>\n<li>Fungal cultures <strong>(Option A)</strong></li>\n<li>Serum eosinophilia</li>\n<li>Charcot-Leyden crystals</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old patient presents with right-sided nasal obstruction and occasional blood-stained nasal discharge. His CT and endoscopy findings are shown in the below image. What could be the underlying cause?", "options": [{"label": "A", "text": "Inverted papilloma", "correct": true}, {"label": "B", "text": "Carcinoma maxilla", "correct": false}, {"label": "C", "text": "Esthesioneuroblastoma", "correct": false}, {"label": "D", "text": "Nasopharyngeal angiofibroma", "correct": false}], "correct_answer": "A. Inverted papilloma", "question_images": ["https://image.prepladder.com/notes/vbdspoDNwwp8s42c9TAu1747047921.png", "https://image.prepladder.com/notes/xpc5TR231N43kF6LleXi1747047942.png"], "explanation_images": ["https://image.prepladder.com/content/6fBjK3pWq73l2WBp7G4W1745567788.png", "https://image.prepladder.com/content/GqkpNrGFdEDHpqXFWxFJ1745567797.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inverted Papilloma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arises from the <strong>non-olfactory mucosa</strong> (Schneiderian membrane) of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and <span class=\"customMeta\" data-dictid=\"e23ca9914316927771948eba43a1e9\">paranasal</span> sinuses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Names</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transitional cell papilloma, Ringertz tumor, Schneiderian papilloma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Most Common Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral wall of the nose</strong>, particularly in the <strong>middle meatus.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inward growth</strong> of hyperplastic tissue toward the stroma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Association with HPV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Linked to Human Papillomavirus (HPV)</strong> infection (particularly types<strong> 6 and 11</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk of Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Associated with <strong>squamous cell carcinoma</strong> in <strong>10-15%</strong> of cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction, <span class=\"customMeta\" data-dictid=\"26bb4e3cc81692777187ce44e530e5\">epistaxis</span> (nosebleeds), and possible <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endoscopic examination and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> for histopathological confirmation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary treatment is <strong>complete <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> excision</strong> to minimize the risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> and <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a person who has facial swelling and orbital edema on the left side of their face after a minor trauma involving a piece of wood 20 days ago? The CT scan showed no abnormalities in the sinuses but revealed subcutaneous nodules. Microscopic examination of tissue sections showed positivity for PAS stain and Grocott's methenamine silver stain.", "options": [{"label": "A", "text": "Phycomycosis", "correct": true}, {"label": "B", "text": "Midline lethal granuloma", "correct": false}, {"label": "C", "text": "Foreign body granuloma", "correct": false}, {"label": "D", "text": "IgG4 granuloma", "correct": false}], "correct_answer": "A. Phycomycosis", "question_images": ["https://image.prepladder.com/notes/QyTXhOigan7eKRddmiUK1747047144.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A severe fungal infection primarily affects the nose and sinuses but can quickly spread to the orbit, <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate, meninges, and brain. The <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> invades arteries, causing endothelial damage, thrombosis, and rapid tissue destruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black necrotic material in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, eroding the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, hard palate, and turbinates. <strong>Black <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> sign</strong> is seen on contrast enhanced MRI.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uncontrolled diabetes, especially with ketoacidosis</li>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use (common in COVID-19 treatment)</li>\n<li>Conditions causing immunosuppression: Neutropenia, HIV/AIDS, chemotherapy, organ transplants, and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> issues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Endoscopy:</strong> Shows pale <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> early, progressing to black crusts and sloughing.</li>\n<li><strong>Biopsy:</strong> Multiple sites should be sampled for fungal identification; <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"0a57b1bc5916927771895a4f4e60b4\">hydroxide</span> preparation is the <strong>gold standard</strong><strong> </strong>for confirming <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> features.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT</strong>: Detects bony destruction and initial assessment of <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> involvement.</li>\n<li><strong>CECT: </strong>CECT provides better delineation of soft tissue structures, allowing for <span class=\"customMeta\" data-dictid=\"55436411c216927771846e318f45ce\">clearer</span> identification of mucosal thickening, <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> opacification, and bony destruction.</li>\n<li><strong>MRI</strong>: Evaluates soft tissue invasion, assesses the extent of extra-sinus disease, and identifies complications, especially in the <strong>orbit and brain</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antifungal Therapy</strong>:</p>\n<ul>\n<li>Amphotericin B: 0.6 to 1 mg/kg/day IV or liposomal Amphotericin B: 5 mg/kg/day.</li>\n<li>Posaconazole: 300 mg twice daily orally on the first day, then 300 mg once daily.</li>\n</ul>\n<p><strong>Surgical Intervention</strong>:</p>\n<ul>\n<li>Endoscopic debridement of necrotic tissues.</li>\n<li>Severe cases: Total/Partial <span class=\"customMeta\" data-dictid=\"7e1612510d1692777192cfe698ecc1\">maxillectomy</span> or <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"b26b12affb16927771872ba42c137b\">exenteration</span> may be required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Choose the best description for the structure marked in the CT given below.", "options": [{"label": "A", "text": "Agger nasi cell", "correct": false}, {"label": "B", "text": "Pneumatised superior turbinate", "correct": true}, {"label": "C", "text": "Onodi cell", "correct": false}, {"label": "D", "text": "Haller cell", "correct": false}], "correct_answer": "B. Pneumatised superior turbinate", "question_images": ["https://image.prepladder.com/notes/nYx5AiH8fLIwB6428Dex1745401785.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes the Little's area?", "options": [{"label": "A", "text": "Keisselbach’s plexus is present in the Little’s area", "correct": true}, {"label": "B", "text": "It is situated at the posteroinferior part of the nasal septum", "correct": false}, {"label": "C", "text": "Least common site for epistaxis", "correct": false}, {"label": "D", "text": "Anastomoses of 7 major arteries occur here", "correct": false}], "correct_answer": "A. Keisselbach’s plexus is present in the Little’s area", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lWN9I33ZT5Z98f5tIIrX1746097061.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:541px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Branch of</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphenopalatine artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maxillary artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ophthalmic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (from internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Greater <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maxillary artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"59733f304e1692777191d9deb34f10\">labial</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Facial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (from external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a 14-year-old male who has been experiencing repeated nosebleeds, without any history of injury, along with nasal blockage and excessive nasal discharge? During examination, a solid, purplish growth is observed on the back of the nasopharynx.", "options": [{"label": "A", "text": "Nasopharyngeal carcinoma", "correct": false}, {"label": "B", "text": "Rhabdomyosarcoma", "correct": false}, {"label": "C", "text": "Pyogenic granuloma", "correct": false}, {"label": "D", "text": "Juvenile nasopharyngeal angiofibroma", "correct": true}], "correct_answer": "D. Juvenile nasopharyngeal angiofibroma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Juvenile <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site of Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, near the superior margin of the <span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\">sphenopalatine</span> foramen, where the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> and <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> bones meet.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gross Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reddish-purple, lobulated, <span class=\"customMeta\" data-dictid=\"3f6a2302971692777198a107e73204\">sessile</span> mass covered by mucosa; lacks a <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> despite being benign.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopic Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vascular Tissue: Endothelium-lined spaces with incomplete/absent muscle coats, leading to bleeding; <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> vessels are thin-walled, central vessels hyperplastic.</li>\n<li>Stromal Cells: <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">Stellate</span> or spindle-shaped cells that produce collagen, affecting tumor firmness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunohistochemistry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fibroblasts, collagen, myofibroblasts, <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells, and occasionally giant cells are present.</li>\n<li>Reactivity to smooth muscle <span class=\"customMeta\" data-dictid=\"8e023fb81e16927771802d21820404\">actin</span> and beta-catenin, suggesting beta-catenin’s role in growth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Growth Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>JNA development likely results from a combination of hormonal influence, growth factors, and genetic factors.</li>\n<li>Androgen Receptors: Present in 75% of JNA tumors, indicating male hormone involvement.</li>\n<li>VEGF: Promotes endothelial and stromal cell growth.</li>\n<li>IGF-II: Role is less clear.</li>\n<li>Genetics: C-MYC <span class=\"customMeta\" data-dictid=\"07aa4138b11692777196389334280a\">proto-oncogene</span> found in larger tumors; may interact with <span class=\"customMeta\" data-dictid=\"426898277b1692777181c2186c29da\">androgen</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> and beta-catenin genes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most common site for head and neck cancer in India?", "options": [{"label": "A", "text": "Nasopharynx", "correct": false}, {"label": "B", "text": "Oropharynx", "correct": false}, {"label": "C", "text": "Oral cavity", "correct": true}, {"label": "D", "text": "Hypopharynx", "correct": false}], "correct_answer": "C. Oral cavity", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent course of action in managing a patient who arrives at the emergency department with epistaxis, despite unsuccessful attempts to stop the bleeding by pinching the nostrils and nasal packing?", "options": [{"label": "A", "text": "Ligation of external carotid artery", "correct": false}, {"label": "B", "text": "Ligation of internal carotid artery", "correct": false}, {"label": "C", "text": "Ligation of sphenopalatine artery", "correct": true}, {"label": "D", "text": "Ligation of maxillary artery", "correct": false}], "correct_answer": "C. Ligation of sphenopalatine artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\"&gt;Ligation&lt;/span&gt; of &lt;span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\"&gt;sphenopalatine&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the view that provides the optimal visualization of the maxillary sinus?", "options": [{"label": "A", "text": "Water’s view", "correct": true}, {"label": "B", "text": "Towne’s view", "correct": false}, {"label": "C", "text": "Law’s view", "correct": false}, {"label": "D", "text": "Stenver’s view", "correct": false}], "correct_answer": "A. Water’s view", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Tj46zufMvR9KvXedG3uj1745844860.png", "https://image.prepladder.com/content/bxtLLsxdgA3aZXbIB70x1745844873.png", "https://image.prepladder.com/content/T8HGELed4qWsEYkqb6lI1745844886.png", "https://image.prepladder.com/content/jsKfqlDE2hJX3Y4Q3T961745844899.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Waters' View (Occipitomental View)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chin-up position.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the maxillary sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ng, Qi Xiong &amp; Lim, Xiao &amp; Chong, Jia &amp; Hanafi, Hanida &amp; Lim, Lik Thai. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Plain-skull-X-ray-occipitomental-view-Waters-view-showing-a-black-eyebrow-sign-as_fig2_375528241\" data-tags=\"\" height=\"356\" src=\"https://image.prepladder.com/content/Tj46zufMvR9KvXedG3uj1745844860.png\" width=\"419\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pierre’s View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to Waters' view but with the <strong>mouth open</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bálint Botz\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/normal-waters-view-skull-x-ray\" data-tags=\"\" height=\"367\" src=\"https://image.prepladder.com/content/bxtLLsxdgA3aZXbIB70x1745844873.png\" width=\"408\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caldwell View (Occipitofrontal View)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chin-down position.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Best view to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hamed Ebrahimnejad, Seyed Hosein Hoseini Zarch,Adineh Javadian langaroodi\" data-hash=\"\" data-license=\"CC BY NC 3.0\" data-source=\"https://www.researchgate.net/figure/A-Caldwell-radiograph-showing-opacification-of-frontal-and-ethmoidal-sinuses_fig2_309859475\" data-tags=\"\" height=\"476\" src=\"https://image.prepladder.com/content/T8HGELed4qWsEYkqb6lI1745844886.png\" width=\"445\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral View</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral (as the name indicates)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allows <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> of all sinuses (frontal, maxillary, sphenoid, and ethmoidal).</p>\n<p>Helps to understand the <span class=\"customMeta\" data-dictid=\"e80b9923cb1692777195fad978604a\">pneumatization</span> pattern of the <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> sinus.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Murphy A, Er A, Bell D,\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/paranasal-sinuses-and-facial-bones-radiography/\" data-tags=\"\" height=\"334\" src=\"https://image.prepladder.com/content/jsKfqlDE2hJX3Y4Q3T961745844899.png\" width=\"445\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for an older diabetic woman,who received steroids and remdesivir for COVID, and is now experiencing a malodorous black discharge from her nose? On examination a necrotic black mass, filling the nasal cavity and causing erosion of the septum and hard palate is found.", "options": [{"label": "A", "text": "Aspergillosis", "correct": false}, {"label": "B", "text": "Mucormycosis", "correct": true}, {"label": "C", "text": "Foreign body", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "B. Mucormycosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A severe fungal infection primarily affects the nose and sinuses but can quickly spread to the orbit, <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate, meninges, and brain. The <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> invades arteries, causing endothelial damage, thrombosis, and rapid tissue destruction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Black necrotic material in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, eroding the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, hard palate, and turbinates. <strong>Black <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> sign</strong> is seen on contrast enhanced MRI.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Uncontrolled diabetes, especially with ketoacidosis</li>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use (common in <span class=\"customMeta\" data-dictid=\"2d364aeaf7169277718529fa58f6ea\">COVID-19</span> treatment)</li>\n<li>Conditions causing immunosuppression: Neutropenia, HIV/AIDS, chemotherapy, organ transplants, and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> issues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Endoscopy:</strong> Shows pale <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> early, progressing to black crusts and sloughing.</li>\n<li><strong>Biopsy:</strong> Multiple sites should be sampled for fungal identification; <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"0a57b1bc5916927771895a4f4e60b4\">hydroxide</span> preparation is the <strong>gold standard</strong><strong> </strong>for confirming <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> features.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CT</strong>: Detects bony destruction and initial assessment of <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> involvement.</li>\n<li><strong>CECT: </strong>CECT provides better delineation of soft tissue structures, allowing for <span class=\"customMeta\" data-dictid=\"55436411c216927771846e318f45ce\">clearer</span> identification of mucosal thickening, <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> opacification, and bony destruction.</li>\n<li><strong>MRI</strong>: Evaluates soft tissue invasion, assesses the extent of extra-sinus disease, and identifies complications, especially in the <strong>orbit and brain</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antifungal Therapy</strong>:</p>\n<ul>\n<li>Amphotericin B: 0.6 to 1 mg/kg/day IV or liposomal Amphotericin B: 5 mg/kg/day.</li>\n<li>Posaconazole: 300 mg twice daily orally on the first day, then 300 mg once daily.</li>\n</ul>\n<p><strong>Surgical Intervention</strong>:</p>\n<ul>\n<li>Endoscopic debridement of necrotic tissues.</li>\n<li>Severe cases: Total/Partial <span class=\"customMeta\" data-dictid=\"7e1612510d1692777192cfe698ecc1\">maxillectomy</span> or <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"b26b12affb16927771872ba42c137b\">exenteration</span> may be required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sinus marked in the image.", "options": [{"label": "A", "text": "Frontal sinus", "correct": false}, {"label": "B", "text": "Pyriform sinus", "correct": false}, {"label": "C", "text": "Ethmoid sinus", "correct": false}, {"label": "D", "text": "Maxillary sinus", "correct": true}], "correct_answer": "D. Maxillary sinus", "question_images": ["https://image.prepladder.com/notes/IX9qkOO816uP9A4XJXDl1747897786.png"], "explanation_images": ["https://image.prepladder.com/content/SswZBndAH97r86FvLGtx1745844147.png", "https://image.prepladder.com/content/ROsxZpvVarCL8HF8vJop1745844162.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended course of action for managing a 6-year-old boy who fell from a bed and now has swelling in his nose, along with breathing difficulties? During examination, it was observed that there are smooth, rounded swellings on both sides of the septum, visible through both nostrils. On palpation, the swellings were found to be soft and fluctuant.", "options": [{"label": "A", "text": "Systemic antibiotics", "correct": false}, {"label": "B", "text": "Incision and drainage", "correct": true}, {"label": "C", "text": "High-resolution computerized tomography", "correct": false}, {"label": "D", "text": "Submucosal resection", "correct": false}], "correct_answer": "B. Incision and drainage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cSkVk50IOvKfVHcporot1745843346.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collection of blood under the <span class=\"customMeta\" data-dictid=\"f6fce4967b16927771956fcb228bb9\">perichondrium</span> or <span class=\"customMeta\" data-dictid=\"ae97d0e84f169277719537f321c02b\">periosteum</span> of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum.</li>\n<li>Commonly caused by:\n\t\t\t\t<ul>\n<li>Nasal trauma.</li>\n<li>Septal surgery.</li>\n<li>Spontaneous occurrence in <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> disorders.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (most common symptom).</li>\n<li>Frontal headache and pressure over the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> bridge.</li>\n<li>Smooth, rounded, soft, and <span class=\"customMeta\" data-dictid=\"1adaaa6ded16927772023e7fe0c856\">fluctuant</span> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in both <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"919be7b0a31692777203eb1a856f99\">fossae</span> (or sometimes unilateral).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Small hematomas:</u> Aspirated with a wide-bore <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> needle.</li>\n<li><u>Larger hematomas:</u> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">Incision</span> and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> via a septal <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> floor, excising a small piece of <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> for better drainage.</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> on both sides to prevent reaccumulation.</li>\n<li>Systemic antibiotics to prevent septal abscess.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibrous tissue formation leads to permanent septal thickening if untreated.</li>\n<li>Secondary infection may lead to septal abscess, <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> necrosis, and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> depression.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is not used for testing olfaction?", "options": [{"label": "A", "text": "Smell diskettes", "correct": false}, {"label": "B", "text": "Arnold stick test", "correct": true}, {"label": "C", "text": "UPSIT", "correct": false}, {"label": "D", "text": "CC-SIT", "correct": false}], "correct_answer": "B. Arnold stick test", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female presents with nasal obstruction and post-nasal drip. She has a history of FESS following failed conservative management 5 years ago. Post-surgical notes mentioned that uncinectomy and maxillary ostium dilation were done during the previous FESS. DNE currently shows patent ostia and mucosal edema of the maxillary sinus lining. What is the next best step in management?", "options": [{"label": "A", "text": "Repeat surgery", "correct": false}, {"label": "B", "text": "Macrolides for 4 months", "correct": false}, {"label": "C", "text": "Steroid irrigation and antihistamines", "correct": true}, {"label": "D", "text": "Biological therapy", "correct": false}], "correct_answer": "C. Steroid irrigation and antihistamines", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lifestyle Modifications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avoid triggers such as sudden temperature changes, humidity, air blasts, and dust. Practical changes to minimise symptom triggers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pharmacological Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong><u>Antihistamines and Decongestants:</u></strong><strong> </strong>Alleviate <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction, sneezing, and rhinorrhoea.</li>\n<li><strong><u>Topical <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Sprays:</u></strong><strong> </strong>Control Symptoms. Eg. Beclomethasone dipropionate, budesonide, fluticasone</li>\n<li><strong><u>Systemic Steroids:</u></strong> Used for severe cases for a short time</li>\n<li><u>Ipratropium <span class=\"customMeta\" data-dictid=\"749f9a02041692777183f4f13efcc5\">Bromide</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Spray:</u> Effective for Excessive Rhinorrhoea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Psychological Support</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Address emotional factors; consider counselling and tranquillisers.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presents to the OPD with a saddle nose deformity. He gives a history of cough, on-and-off fever, and hemoptysis. On examination, septal perforation is present with granulations in the nose. His chest X-ray showed multiple cavitary lesions, and the biopsy showed granuloma, multinucleated giant cells, and necrosis. What is the probable cause?", "options": [{"label": "A", "text": "Wegener's granulomatosis", "correct": true}, {"label": "B", "text": "Tuberculosis", "correct": false}, {"label": "C", "text": "Syphilis", "correct": false}, {"label": "D", "text": "Sarcoidosis", "correct": false}], "correct_answer": "A. Wegener's granulomatosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent tests is not applicable for evaluating nasal mucociliary clearance?", "options": [{"label": "A", "text": "Saccharine test", "correct": false}, {"label": "B", "text": "Electron microscopy", "correct": true}, {"label": "C", "text": "Charcoal powder method", "correct": false}, {"label": "D", "text": "Scintigraphy", "correct": false}], "correct_answer": "B. Electron microscopy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following least likely causes nasal septal perforation?", "options": [{"label": "A", "text": "Rhinosporidiosis", "correct": false}, {"label": "B", "text": "Seasonal influenza", "correct": true}, {"label": "C", "text": "Syphilis", "correct": false}, {"label": "D", "text": "Tuberculosis", "correct": false}], "correct_answer": "B. Seasonal influenza", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which clinical test is being shown in the image?", "options": [{"label": "A", "text": "Epley’s maneuver", "correct": false}, {"label": "B", "text": "Heimlich maneuver", "correct": false}, {"label": "C", "text": "Cottle’s test", "correct": true}, {"label": "D", "text": "Trotter’s method", "correct": false}], "correct_answer": "C. Cottle’s test", "question_images": ["https://image.prepladder.com/content/bbZBeqEk3WJyHCJmJoEw1747123167.png"], "explanation_images": [], "explanation": "<p>Correct Answer C- Cottle’s test.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the sign depicted in the contrast-enhanced CT scan of the head shown below in a 14-year-old football player who presented to the casualty with complaints of epistaxis while playing football, along with a history of recurrent spontaneous nasal bleeding, unilateral nasal obstruction, and denasal speech, without any history of trauma or falls?", "options": [{"label": "A", "text": "Aquino Sign", "correct": false}, {"label": "B", "text": "Holman Miller sign", "correct": true}, {"label": "C", "text": "Teardrop sign", "correct": false}, {"label": "D", "text": "Hanging drop sign", "correct": false}], "correct_answer": "B. Holman Miller sign", "question_images": ["https://image.prepladder.com/content/wBHk6e27LtdNbAYPbAIA1747122926.png"], "explanation_images": [], "explanation": "<p>Correct Answer B- Holman Miller Sign.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man presents with complaints of a facial deformity, as shown in the image below. His medical records show a history of acne rosacea. What is the likely diagnosis?", "options": [{"label": "A", "text": "Rhinophyma", "correct": true}, {"label": "B", "text": "Rhinoscleroma", "correct": false}, {"label": "C", "text": "Rhinosporidiosis", "correct": false}, {"label": "D", "text": "Scleroderma", "correct": false}], "correct_answer": "A. Rhinophyma", "question_images": ["https://image.prepladder.com/content/rDOaVabsGEvoIjBUMxTi1747122657.png"], "explanation_images": [], "explanation": "<p>Correct Answer A- Rhinoph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 70-year-old man who has neck nodes and exhibits a dull tympanic membrane, along with symptoms of deafness and tinnitus in the left ear, and a type B graph on tympanometry?", "options": [{"label": "A", "text": "Chronic suppurative otitis media", "correct": false}, {"label": "B", "text": "Glomus tumor", "correct": false}, {"label": "C", "text": "Nasopharyngeal carcinoma", "correct": true}, {"label": "D", "text": "Sensorineural hearing loss", "correct": false}], "correct_answer": "C. Nasopharyngeal carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- &lt;span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\"&gt;Nasopharyngeal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age frontal sinuses appear on X ray?", "options": [{"label": "A", "text": "1 years", "correct": false}, {"label": "B", "text": "2 years", "correct": false}, {"label": "C", "text": "3 years", "correct": false}, {"label": "D", "text": "4 years", "correct": true}], "correct_answer": "D. 4 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D- 4\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rhinolalia clausa occurs in all except:", "options": [{"label": "A", "text": "Nasopharyngeal polyp", "correct": false}, {"label": "B", "text": "Nasopharyngeal carcinoma", "correct": false}, {"label": "C", "text": "Cleft palate", "correct": true}, {"label": "D", "text": "Nasopharyngeal angiofibroma", "correct": false}], "correct_answer": "C. Cleft palate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C- &lt;span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\"&gt;Cleft&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young adult presents with a deformed nose after falling from a ladder. The CT scan shows a displaced nasal fracture. What is the ideal time to reduce the fracture in this patient?", "options": [{"label": "A", "text": "Within 12 hours following the injury", "correct": false}, {"label": "B", "text": "5-7 days following injury", "correct": true}, {"label": "C", "text": "After 2 weeks of injury", "correct": false}, {"label": "D", "text": "After 4 weeks of injury", "correct": false}], "correct_answer": "B. 5-7 days following injury", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B- 5-7 days following inju\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A boy fell down while playing and presented with deviated nose. The septum however was found to be normal. Following is the CT finding of the patient. What is the next step in management?", "options": [{"label": "A", "text": "Septo-rhinoplasty", "correct": false}, {"label": "B", "text": "Open reduction", "correct": false}, {"label": "C", "text": "Closed reduction after edema subsides in 20 days", "correct": false}, {"label": "D", "text": "Closed reduction and swelling will decrease automatically", "correct": true}], "correct_answer": "D. Closed reduction and swelling will decrease automatically", "question_images": ["https://image.prepladder.com/content/MWSVjogAH93m2fqBGjHf1747981527.png"], "explanation_images": [], "explanation": "<p>Correct Answer D- &lt;span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\"&gt;Closed reduction&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\"&gt;swelling&lt;/span&gt; will decrease au\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fracture in the given diagram:", "options": [{"label": "A", "text": "Chevallet fracture", "correct": true}, {"label": "B", "text": "Jarjaway fracture", "correct": false}, {"label": "C", "text": "Le Fort 1", "correct": false}, {"label": "D", "text": "Simple fracture", "correct": false}], "correct_answer": "A. Chevallet fracture", "question_images": ["https://image.prepladder.com/content/vK0xf6AWnbTC39Y0nvDb1741276016.png"], "explanation_images": ["https://image.prepladder.com/content/VSwFAJMIxzsh4uWsKPXX1741276030.png", "https://image.prepladder.com/content/ZPBp2FrY5p9kwunyxhxQ1741276078.png", "https://image.prepladder.com/content/KBljOke96X6DeRGEkT6D1741276112.png", "https://image.prepladder.com/content/6L4LU1Or8HArAksm6EiL1741276173.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:688px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class I</strong></p>\n<p><strong>(Chevallet Fracture)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class II</strong></p>\n<p><strong>(Jarjavay Fracture)</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class III</strong></p>\n<p><strong>(Naso-orbito-ethmoid fracture)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blows from below</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Impacts directed from the front</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-velocity trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture Line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vertical fracture</strong> from the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> spine upwards to the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of the bony and <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the nose.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Horizontal <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> </strong>starting just above the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> spine, running backwards just above the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> of septal <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and vomer.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves external buttresses of the nose and <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> labyrinth.</p>\n<p><strong>Pig-like appearance </strong>with foreshortened, saddled nose.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Relations:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Assess for <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and deformity.</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> might only develop later, especially in children.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Check for <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> greater than half the <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> of the nose, which may indicate a septal fracture.</li>\n<li>Requires reduction of both <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> and septal fractures.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Look for signs of more severe injuries, such as <strong>CSF leaks</strong>, multiple <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> tears, and potential cerebral herniation.</li>\n<li>Evaluate for <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> and skull base involvement.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/VSwFAJMIxzsh4uWsKPXX1741276030.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/ZPBp2FrY5p9kwunyxhxQ1741276078.png\" width=\"500\"/></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/KBljOke96X6DeRGEkT6D1741276112.png\" width=\"500\"/></td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:758px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Le Fort I</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Le Fort II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Le Fort III</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Also known as</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Guerin’s <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">Transverse</span> fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyramidal fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Craniofacial disjunction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fracture line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Runs above and <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> to the palate, crossing the lower <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, maxillary antra, and <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Passes through the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> root, <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> bone, <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> floor, upper maxillary sinus, and <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates</p>\n\t\t\t \n\n\t\t\t<p><strong>Note:</strong> can cause <span class=\"customMeta\" data-dictid=\"6c3d094a46169277719011ea38746a\">infraorbital</span> nerve injury.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Traverses the root of the nose, ethmoid-frontal junction, superior <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> fissure, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> wall, <span class=\"customMeta\" data-dictid=\"65363ac32f16927772030370304d8d\">frontozygomatic</span> and <span class=\"customMeta\" data-dictid=\"fd1ce80ae51692777200b766483942\">temporozygomatic</span> sutures, and the upper <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Characteristic feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hanging <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> and hanging <span class=\"customMeta\" data-dictid=\"17dfb015d2169277720023db8fe9e5\">teeth</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hanging maxilla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> bones from the <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> bones</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF <span class=\"customMeta\" data-dictid=\"7eef11dffd16927771971632a8614e\">Rhinorrhea</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May be present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High risk of <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> Rhinorrhea</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent location of obstruction caused by a nasal polyp originating from the maxillary sinus?", "options": [{"label": "A", "text": "Inferior meatus", "correct": false}, {"label": "B", "text": "Superior meatus", "correct": false}, {"label": "C", "text": "Middle meatus", "correct": true}, {"label": "D", "text": "Sphenoethmoidal recess", "correct": false}], "correct_answer": "C. Middle meatus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred diagnostic procedure prior to performing functional endoscopic sinus surgery (FESS)?", "options": [{"label": "A", "text": "MRI scan", "correct": false}, {"label": "B", "text": "X-ray", "correct": false}, {"label": "C", "text": "Antral lavage", "correct": false}, {"label": "D", "text": "CT scan", "correct": true}], "correct_answer": "D. CT scan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the condition where surgery is done to partially or completely occlude one nostril?", "options": [{"label": "A", "text": "Vasomotor rhinitis", "correct": false}, {"label": "B", "text": "Atrophic rhinitis", "correct": true}, {"label": "C", "text": "Invasive aspergillosis", "correct": false}, {"label": "D", "text": "Allergic rhinitis", "correct": false}], "correct_answer": "B. Atrophic rhinitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following views involves an X-ray beam angled at 45° to the orbitomeatal line is also known as?", "options": [{"label": "A", "text": "Water’s view", "correct": true}, {"label": "B", "text": "Towne’s view", "correct": false}, {"label": "C", "text": "Law’s view", "correct": false}, {"label": "D", "text": "Stenver’s view", "correct": false}], "correct_answer": "A. Water’s view", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Water’s v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is not a division of external carotid artery within Kiesselback's plexus?", "options": [{"label": "A", "text": "Anterior ethmoidal artery", "correct": true}, {"label": "B", "text": "Sphenopalatine artery", "correct": false}, {"label": "C", "text": "Greater palatine artery", "correct": false}, {"label": "D", "text": "Septal branch of superior labial", "correct": false}], "correct_answer": "A. Anterior ethmoidal artery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the first air cell of the anterior ethmoidal sinus called?", "options": [{"label": "A", "text": "Bulla ethmoidalis", "correct": false}, {"label": "B", "text": "Onodi cell", "correct": false}, {"label": "C", "text": "Agger nasi", "correct": true}, {"label": "D", "text": "Haller cell", "correct": false}], "correct_answer": "C. Agger nasi", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the structure indicated in the endoscopic image of the right nasal cavity.", "options": [{"label": "A", "text": "Inferior turbinate", "correct": true}, {"label": "B", "text": "Middle turbinate", "correct": false}, {"label": "C", "text": "Superior turbinate", "correct": false}, {"label": "D", "text": "Uncinate process", "correct": false}], "correct_answer": "A. Inferior turbinate", "question_images": ["https://image.prepladder.com/notes/UJ6c5wOyp4MC2Akcaa6N1746599418.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the commonly used name for the view shown in the radiograph below, which is used to assess the frontal sinus more effectively?", "options": [{"label": "A", "text": "Water’s view", "correct": false}, {"label": "B", "text": "Caldwell view", "correct": true}, {"label": "C", "text": "Pierre’s view", "correct": false}, {"label": "D", "text": "Towne’s view", "correct": false}], "correct_answer": "B. Caldwell view", "question_images": ["https://image.prepladder.com/content/HYR0yGP0aZ9cYhd4TXhF1745585819.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old male with recurrent bleeding, presents with bowing of posterior maxillary wall on CECT. All are false except?", "options": [{"label": "A", "text": "Outgrown the blood supply", "correct": false}, {"label": "B", "text": "Tumor vessels lack contractility", "correct": true}, {"label": "C", "text": "Bleeding is from the adjacent invading blood vessels", "correct": false}, {"label": "D", "text": "It lacks capsule", "correct": false}], "correct_answer": "B. Tumor vessels lack contractility", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examination of Juvenile <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior Rhinoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reveals a reddish-purple mass obstructing the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages, often with blood-stained discharge.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior Rhinoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Visualizes a smooth or <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> mass in the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> using a small mirror.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oral Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses for tumor extension into the oral cavity, possibly pushing the soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> downwards.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neck Palpation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detects any enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, especially in the upper <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> region.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurological Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve involvement, <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> on eye movements, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> sensation, and hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Digital palpation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Caution, avoid </strong>digital <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> of the <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> mass to prevent severe bleeding.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigations of Juvenile <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contrast-Enhanced CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice</strong>; shows tumor size, location, and bony involvement.</li>\n<li>Pathognomonic sign: Holman-Miller sign (bowing of maxillary wall).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Magnetic Resonance Imaging (MRI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evaluates soft tissue and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension, differentiates between <span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\">extradural</span> and <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> spread. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Digital Subtraction Angiography (DSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Visualizes tumor vascularity, identifies <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels and aids in <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> to reduce <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> blood loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nasopharyngoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides a direct view of the tumor, but <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is generally avoided due to high <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> caused by Eustachian tube obstruction; establishes <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> and monitors post-treatment hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Biopsy is<strong> contraindicated</strong> due to risk of profuse bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structure does the anterior ethmoidal sinus drain into?", "options": [{"label": "A", "text": "Middle meatus", "correct": true}, {"label": "B", "text": "Inferior meatus", "correct": false}, {"label": "C", "text": "Superior meatus", "correct": false}, {"label": "D", "text": "Sphenoethmoidal recess", "correct": false}], "correct_answer": "A. Middle meatus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Air-filled cavities within the <strong>ethmoid bone</strong></li>\n<li>Part of the <strong>ethmoidal sinus</strong> system</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Between the <strong>nasal cavity</strong> and the <strong>orbit</strong></li>\n<li>Anterior group of <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> air cells (compared to middle/posterior groups)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Drainage Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>Drains into the <strong>middle meatus</strong> of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> via the <strong>infundibulum</strong> and <strong>hiatus semilunaris</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Innervation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>Supplied by the <strong>anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> nerve</strong>, a branch of the <strong>nasociliary nerve</strong> (from CN V1 – <span class=\"customMeta\" data-dictid=\"c09776e61f1692777194db295c590f\">ophthalmic</span> division)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Blood Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>Anterior <span class=\"customMeta\" data-dictid=\"8c73ef522416927771878a2a17e9bc\">ethmoidal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (branch of <strong>ophthalmic artery</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Can be involved in <strong>sinusitis</strong> (especially if <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is blocked)</li>\n<li>Close to <strong>orbit</strong> and <strong>anterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong> — risk of <strong>orbital cellulitis</strong> or <strong>intracranial spread</strong> if infected</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the staging system used for Juvenile Nasopharyngeal Angiofibroma?", "options": [{"label": "A", "text": "Radkowski’s", "correct": true}, {"label": "B", "text": "TNM Staging", "correct": false}, {"label": "C", "text": "Ann Arbor Staging System", "correct": false}, {"label": "D", "text": "Dukes criteria", "correct": false}], "correct_answer": "A. Radkowski’s", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement limited to the nose or naso-pharynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>I B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extension into one or more sinuses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minimal extension into <span class=\"customMeta\" data-dictid=\"e10a7d508b16927771960a2f2fa92a\">pterygopalatine</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Occupies the entire <span class=\"customMeta\" data-dictid=\"e10a7d508b16927771960a2f2fa92a\">pterygopalatine</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> with or without <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> арех</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involvement of the <span class=\"customMeta\" data-dictid=\"5b1134ed2e169277719040dbf157ba\">infratemporal</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> with or without extension to the cheek or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>III A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erosion of the skull base (the middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa/base of the pterygoids), minimal <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>III B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erosion of the skull base, extensive <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension with or without <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> invasion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structure is most commonly involved in the compression of the anterior ethmoid nerve, leading to Sluder's neuralgia?", "options": [{"label": "A", "text": "Superior turbinate", "correct": false}, {"label": "B", "text": "Middle turbinate", "correct": true}, {"label": "C", "text": "Inferior turbinate", "correct": false}, {"label": "D", "text": "Nasal septum", "correct": false}], "correct_answer": "B. Middle turbinate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred initial management for a patient presenting with cerebrospinal fluid (CSF) rhinorrhea?", "options": [{"label": "A", "text": "Functional Endoscopic Sinus Surgery (FESS)", "correct": false}, {"label": "B", "text": "Administration of steroids", "correct": false}, {"label": "C", "text": "Bed rest with head elevation and avoidance of straining activities", "correct": true}, {"label": "D", "text": "Immediate surgical repair without initial medical management", "correct": false}], "correct_answer": "C. Bed rest with head elevation and avoidance of straining activities", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the most common location of Nasopharyngeal carcinoma:", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": true}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "B. 2", "question_images": ["https://image.prepladder.com/content/rCecS6HsSutc1DyPaOIE1747372740.png"], "explanation_images": ["https://image.prepladder.com/content/CLQniT0CD4PQRmPSFHst1747372841.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• A deep <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> located in the <strong>nasopharynx</strong>, behind the <strong>torus tubarius</strong> (the <span class=\"customMeta\" data-dictid=\"a2a990a23c1692777183c6b47c7819\">cartilaginous</span> opening of the Eustachian tube)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• <strong>Posterolateral wall of the nasopharynx</strong></p>\n<p>• Just <strong>behind the Eustachian tube opening</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Clinical Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• Common site for <strong>nasopharyngeal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (NPC)</strong> origin</p>\n<p>• Close to the <strong>pharyngeal opening of the Eustachian tube</strong>, so tumors here may cause <strong>ear symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Related Structures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• Close to the <strong>Eustachian tube</strong>, <strong>tensor and <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> veli palatini muscles</strong>, and <strong>retropharyngeal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Symptoms if Involved</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>• <strong>Unilateral ear <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> or hearing loss</strong> (due to Eustachian tube obstruction)</p>\n<p>• <strong>Nasal obstruction</strong>, <strong>epistaxis</strong> (nosebleeds)</p>\n<p>• <strong>Neck mass</strong> (from <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> spread)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following signs is not typically seen in allergic rhinitis?", "options": [{"label": "A", "text": "Allergic shiners", "correct": false}, {"label": "B", "text": "Allergic salute", "correct": false}, {"label": "C", "text": "Otto vergauth folds", "correct": true}, {"label": "D", "text": "Denis morgan lines", "correct": false}], "correct_answer": "C. Otto vergauth folds", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2j5SB4DfTNXUicbbq0P41717753260.png", "https://image.prepladder.com/content/6Yi5DWH8ukbAxT6ekRVd1717753413.png", "https://image.prepladder.com/content/HTzxxuThyLtJVd7ahHU31717753426.png", "https://image.prepladder.com/content/pELfNOc2pyEzzMH7mbp61718015202.png", "https://image.prepladder.com/content/YyUHBf77nHXdK1UXiYff1717753453.png"], "explanation": "<p>Correct Option C - Otto veraguth\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Allergic shiners</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/6Yi5DWH8ukbAxT6ekRVd1717753413.png\" style=\"height:158px; width:300px\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Darrier’s line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/HTzxxuThyLtJVd7ahHU31717753426.png\" style=\"height:353px; width:300px\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Allergic salute</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/pELfNOc2pyEzzMH7mbp61718015202.png\" style=\"height:324px; width:300px\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Denis <span class=\"customMeta\" data-dictid=\"8057385f2d1692777192dbb5247114\">morgan</span> lines</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/YyUHBf77nHXdK1UXiYff1717753453.png\" style=\"height:317px; width:300px\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most commonly affected nerve after parotid surgery?", "options": [{"label": "A", "text": "Facial nerve", "correct": true}, {"label": "B", "text": "Auriculo temporal nerve", "correct": false}, {"label": "C", "text": "Glossopharyngeal nerve", "correct": false}, {"label": "D", "text": "Greater auricular nerve", "correct": false}], "correct_answer": "A. Facial nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/rOIuCYDwYYeERrTqdjh61747303200.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old male presents with right-sided serous otitis media and a history of cervical lymphadenopathy. The probable diagnosis is?", "options": [{"label": "A", "text": "Angiofibroma", "correct": false}, {"label": "B", "text": "Nasopharyngeal cancer", "correct": true}, {"label": "C", "text": "Adenoid hypertrophy", "correct": false}, {"label": "D", "text": "Tonsillar abscess", "correct": false}], "correct_answer": "B. Nasopharyngeal cancer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:707px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Nasal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Obstruction</li>\n<li>Discharge</li>\n<li>Denasal speech (rhinolalia clausa)</li>\n<li>Epistaxis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Otologic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conductive hearing loss</li>\n<li><strong>Serous or <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media (Unilateral <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media in adults is an important indicator)</strong></li>\n<li>Tinnitus</li>\n<li>Dizziness due to Eustachian tube obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ophthalmoneurologic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Squint</li>\n<li>Diplopia (CN VI involvement)</li>\n<li>Ophthalmoplegia (CN III, IV, VI)</li>\n<li>Facial pain</li>\n<li>Reduced corneal <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (CN V involvement)</li>\n<li>Exophthalmos</li>\n<li>Blindness (CN II)</li>\n<li>Jugular <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> syndrome with CN IX, X, and XI involvement</li>\n<li>Horner syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cervical Nodal Metastases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lump of nodes between the angle of the jaw and mastoid, or along the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> triangle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant Metastases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common sites-bone, lung, and liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cervical lymphadenopathy</strong></li>\n<li>Hearing loss</li>\n<li>Nasal obstruction</li>\n<li>Epistaxis</li>\n<li>Cranial nerve palsies (CN VI most common)</li>\n<li>Headache</li>\n<li>Earache</li>\n<li>Neck pain</li>\n<li>Weight loss</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A fracture has occurred at the cribriform plate area of the ethmoid bone. The patient can present with which symptom?", "options": [{"label": "A", "text": "Hearing loss", "correct": false}, {"label": "B", "text": "Visual loss", "correct": false}, {"label": "C", "text": "CSF Rhinorrhoea", "correct": true}, {"label": "D", "text": "Diplopia", "correct": false}], "correct_answer": "C. CSF Rhinorrhoea", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporal bone fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cribriform plate(most common)</strong></li>\n<li>Roof of <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> air cells</li>\n<li>Frontal sinus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenoid sinus(following trauma)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CSF reaches the middle ear, escaping through the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube into the nose(CSF otorhinorrhea)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Type of voice associated with the hypertrophied adenoids?", "options": [{"label": "A", "text": "Rhinolalia clausa", "correct": true}, {"label": "B", "text": "Rhinolalia aperta", "correct": false}, {"label": "C", "text": "Hot potato voice", "correct": false}, {"label": "D", "text": "Hypernasality", "correct": false}], "correct_answer": "A. Rhinolalia clausa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) Rhinolalia clau\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a foul smell from the nose, anosmia, and nasal obstruction. The following is noted during examination. What is the diagnosis?", "options": [{"label": "A", "text": "Atrophic rhinitis", "correct": true}, {"label": "B", "text": "Rhinitis sicca", "correct": false}, {"label": "C", "text": "Rhinitis medicamentosa", "correct": false}, {"label": "D", "text": "Allergic rhinitis", "correct": false}], "correct_answer": "A. Atrophic rhinitis", "question_images": ["https://image.prepladder.com/content/tTAP6NJyjhdatSHH2W7g1747295267.png"], "explanation_images": ["https://image.prepladder.com/content/EJSsIL19e02uHYQoYt4o1747295293.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The incision shown in the given image is typically performed for which of the following surgeries?", "options": [{"label": "A", "text": "Open rhinoplasty", "correct": true}, {"label": "B", "text": "Caldwell-Luc procedure", "correct": false}, {"label": "C", "text": "Septoplasty", "correct": false}, {"label": "D", "text": "Sinusotomy", "correct": false}], "correct_answer": "A. Open rhinoplasty", "question_images": ["https://image.prepladder.com/content/RTxdmaO467NhXqMTjwes1724839517.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Open rh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which sinus drainage is obstructed in the image provided?", "options": [{"label": "A", "text": "Maxillary", "correct": true}, {"label": "B", "text": "Ethmoid", "correct": false}, {"label": "C", "text": "Sphenoid", "correct": false}, {"label": "D", "text": "Frontal", "correct": false}], "correct_answer": "A. Maxillary", "question_images": ["https://image.prepladder.com/content/y9rNFaiYLgEvqg023g9w1724840438.png"], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old child with a history of recurrent bleeding undergoes an endoscopic examination, which is given below. What is the investigation of choice (IOC) for this condition?", "options": [{"label": "A", "text": "Contrast-Enhanced CT (CECT)", "correct": true}, {"label": "B", "text": "Biopsy", "correct": false}, {"label": "C", "text": "X-ray", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "A. Contrast-Enhanced CT (CECT)", "question_images": ["https://image.prepladder.com/content/FHthykvOn3sR9I0y3RRE1724840326.png"], "explanation_images": ["https://image.prepladder.com/content/ePUtKu77EjRQmdyieTav1724840341.png", "https://image.prepladder.com/content/EaIZOkDElsjJIs5jfaVV1724840369.png"], "explanation": "<p>Correct Option A - Contrast-Enhanced CT (CECT)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was presented to the OPD with complaints of greenish black matter in the nose with merciful smelling. What is the diagnosis?", "options": [{"label": "A", "text": "Allergic rhinitis", "correct": false}, {"label": "B", "text": "Atrophic rhinitis", "correct": true}, {"label": "C", "text": "Rhinitis caseosa", "correct": false}, {"label": "D", "text": "Rhinitis sicca", "correct": false}], "correct_answer": "B. Atrophic rhinitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heredity</li>\n<li>Endocrine disturbance</li>\n<li>Racial factors</li>\n<li>Nutritional deficiency</li>\n<li><strong>Infective: <span class=\"customMeta\" data-dictid=\"50f3c6e8dd16927771902c55d555b8\">Klebsiella</span> ozaenae </strong></li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clinical Features</strong></p>\n<p><strong>And Examination findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily affects females, starts around puberty</li>\n<li>Foul-smelling <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge; patients are usually unaware of it themselves and have <span class=\"customMeta\" data-dictid=\"cc8a35010816927771819ba9cf19d8\">anosmia</span> <strong>(merciful anosmia).</strong></li>\n<li>Paradoxical <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> despite enlarged <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> chambers.</li>\n<li>Epistaxis from <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">crust</span> removal.</li>\n<li>Pale <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> mucosa, <span class=\"customMeta\" data-dictid=\"ae1132b13e1692777182aec918eee0\">atrophied</span> turbinates, potential septal perforation, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> dermatitis, <span class=\"customMeta\" data-dictid=\"8b3b29ae5516927771987d1b16beb1\">saddle</span> nose deformity.</li>\n<li>Possible extension to <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">pharynx</span> and <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> leading to <span class=\"customMeta\" data-dictid=\"65b19c9ce61692777182e7b765acf0\">atrophic pharyngitis</span> and laryngitis.</li>\n<li>Eustachian tube <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> cause hearing impairment.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is shown in the image below (circled)?", "options": [{"label": "A", "text": "Columella", "correct": false}, {"label": "B", "text": "Osteomeatal complex", "correct": true}, {"label": "C", "text": "Nasal valve", "correct": false}, {"label": "D", "text": "Crest of maxilla", "correct": false}], "correct_answer": "B. Osteomeatal complex", "question_images": ["https://image.prepladder.com/content/PmLeHcnGCTKIp53FWuuD1741087320.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A South Indian male farmer presents to the ENT OPD with complaints of reddish mass coming out from the nose and histopathology image as given below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Rhinosporidiosis", "correct": true}, {"label": "B", "text": "Rhinoscleroma", "correct": false}, {"label": "C", "text": "Rhinophyma", "correct": false}, {"label": "D", "text": "Nasal polyp", "correct": false}], "correct_answer": "A. Rhinosporidiosis", "question_images": ["https://image.prepladder.com/notes/8eMcESotsNu9MLD9exM91746164728.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What lies posterior to the marked structure?", "options": [{"label": "A", "text": "Odontoid", "correct": false}, {"label": "B", "text": "Eustachian tube", "correct": true}, {"label": "C", "text": "Sphenopalatine foramen", "correct": false}, {"label": "D", "text": "Agger nasi", "correct": false}], "correct_answer": "B. Eustachian tube", "question_images": ["https://image.prepladder.com/content/svA6KQO3nuMIpLYDoj5M1741772784.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male was admitted with respiratory distress. CT showed a nasal polyp with fluid collection in the sinus. Drainage of which of the following is obstructed?", "options": [{"label": "A", "text": "Ethmoidal sinus", "correct": false}, {"label": "B", "text": "Sphenoidal sinus", "correct": false}, {"label": "C", "text": "Frontal sinus", "correct": false}, {"label": "D", "text": "Maxillary sinus", "correct": true}], "correct_answer": "D. Maxillary sinus", "question_images": ["https://image.prepladder.com/content/kkgY4xOUtJ6RmAMm7njV1741062143.png"], "explanation_images": ["https://image.prepladder.com/content/vVU8T4Ryapl4y0hP03kt1741062195.png", "https://image.prepladder.com/content/4poixIXw2H01XmjvYJY51741062221.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the least probable cause of mucormycosis?", "options": [{"label": "A", "text": "Neutropenia", "correct": false}, {"label": "B", "text": "Broad spectrum antibiotics", "correct": true}, {"label": "C", "text": "Uncontrolled diabetes without DKA", "correct": false}, {"label": "D", "text": "Prolonged use of steroid", "correct": false}], "correct_answer": "B. Broad spectrum antibiotics", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman takes aspirin for a headache, later presented with wheezing and breathlessness. Along with these two symptoms, what other clinical findings are likely to be found in this condition?", "options": [{"label": "A", "text": "Eosinophilia", "correct": false}, {"label": "B", "text": "Nasal polyp", "correct": true}, {"label": "C", "text": "Extrinsic asthma", "correct": false}, {"label": "D", "text": "Drug interaction", "correct": false}], "correct_answer": "B. Nasal polyp", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about inverted papilloma?", "options": [{"label": "A", "text": "Malignant and invasive", "correct": false}, {"label": "B", "text": "Benign and non-invasive", "correct": false}, {"label": "C", "text": "Benign and invasive", "correct": true}, {"label": "D", "text": "Malignant and non-invasive", "correct": false}], "correct_answer": "C. Benign and invasive", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lIr10JQssWbpqmqbGgrt1746427558.png", "https://image.prepladder.com/content/kGrZKLDidxMN5nXJH78N1746427558.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a patient who presents with a headache and thick nasal discharge, and upon examination, shows hypertrophy of the inferior turbinate with a mulberry appearance?", "options": [{"label": "A", "text": "Atrophic rhinitis", "correct": false}, {"label": "B", "text": "Common cold", "correct": false}, {"label": "C", "text": "Hypertrophic rhinitis", "correct": true}, {"label": "D", "text": "Nasal polyp", "correct": false}], "correct_answer": "C. Hypertrophic rhinitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly diabetic female patient is presented, as shown in the image. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Aspergillosis", "correct": false}, {"label": "B", "text": "Mucormycosis", "correct": true}, {"label": "C", "text": "Foreign body", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "B. Mucormycosis", "question_images": ["https://image.prepladder.com/content/Qyerd4zcEi6S846Vg7Tp1746423912.png"], "explanation_images": ["https://image.prepladder.com/content/fIc4uKCFSpsSvCVcQ6V11746424037.png", "https://image.prepladder.com/content/d8r7w5CGZs3qa9r9KAdF1746424037.png", "https://image.prepladder.com/content/ORMnaqg20c0yfcR8Avae1746424037.png", "https://image.prepladder.com/content/jxv5CtKQmCYSy3UEPrxd1746424037.png", "https://image.prepladder.com/content/XUKnfaJuvXCkjA99fLou1746424037.png", "https://image.prepladder.com/content/XmLEDWAmhvmaOn4DSoV51746424037.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:730px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is an <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> disease caused by zygomycetes (phycomycetes) - Rhizopus, <span class=\"customMeta\" data-dictid=\"2cd8f411371692777193c9fa32b32c\">Mucor</span> and Absidia. <strong>Rhizopus Arrhizus </strong>is the most common pathogen</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Timleo\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Rhizopus\" data-tags=\"\" height=\"247\" src=\"https://image.prepladder.com/content/fIc4uKCFSpsSvCVcQ6V11746424037.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Rhizopus</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" CDC/Dr. Lucille K. Georg \" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Absidia\" data-tags=\"\" height=\"171\" src=\"https://image.prepladder.com/content/d8r7w5CGZs3qa9r9KAdF1746424037.png\" width=\"249\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Absidia</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Alison Burkett, M.D., Sawanan Saitornuang, B.S., Sixto M. Leal, Jr., M.D., Ph.D.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/microbiologyzygomycetes.html\" data-tags=\"\" height=\"173\" src=\"https://image.prepladder.com/content/ORMnaqg20c0yfcR8Avae1746424037.png\" width=\"305\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align: center;\"><strong>Mucor</strong> (Lactophenol cotton blue stained)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Begins in the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, where spores germinate and <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> mycelia → invade adjacent tissues, leading to local destruction.</p>\n<p>Fungi invade blood vessels, causing <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in affected areas, which contributes to its high mortality rate (Angio-invasiveness)</p>\n<p><strong>Common Sites</strong></p>\n<ul>\n<li><strong>Rhinocerebral Form</strong>: Involves the nose, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> sinuses, and orbit; frequently seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</li>\n<li><strong>Pulmonary Infections</strong>: When the lungs are the primary site, the <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> can invade lung arteries, leading to serious complications.</li>\n<li>Others: Cutaneous mucormycosis, GI mucormycosis, Disseminated mucormycosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rhinocerebral Zygomycosis</strong>:\n\t\t\t\t<ul>\n<li>Facial swelling, <strong>nasal discharge</strong> (often <strong>black</strong>), fever, and <strong>mucosal necrosis</strong>.</li>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> can lead to severe complications, including visual loss and neurological symptoms.</li>\n</ul>\n</li>\n<li><strong>Pulmonary Zygomycosis</strong>:\n\t\t\t\t<ul>\n<li>Symptoms may include cough, fever, and <strong>hemoptysis</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histological Examination</strong>:</p>\n<p>Diagnosis is confirmed by identifying broad, non-septate (or sparsely septate) hyphae.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"259\" src=\"https://image.prepladder.com/content/jxv5CtKQmCYSy3UEPrxd1746424037.png\" width=\"296\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Culture: </strong></p>\n<ul>\n<li>After <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> for 3-4 days on Sabouraud <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> at 30-37°C, the colonies are grey-white with a thick cottony, fluffy surface.</li>\n<li>Under the microscope, nonseptate, broad hyphae with aerial sporangiophores which end in a <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> (a <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> containing spores are seen.)</li>\n</ul>\n<p><strong>a. </strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/XUKnfaJuvXCkjA99fLou1746424037.png\" width=\"222\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> <strong>b</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"\" height=\"191\" src=\"https://image.prepladder.com/content/XmLEDWAmhvmaOn4DSoV51746424037.png\" width=\"247\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>a. Sabouraud's <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">dextrose</span> <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> (SDA) medium showing Rhizopus growth </strong></p>\n<p><strong>b.Microscopy of LPCB stained preparation demonstrating <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> of Rhizopus spp. (non-septate hyphae, sporangiophore, <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> and spores)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intravenous amphotericin B combined, where appropriate, with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is the recommended treatment.</li>\n<li>Medical control of diabetes is required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old male who has nonaxial proptosis in his left eye and a history of a road traffic accident 15 years ago, as suggested by the provided CT image?", "options": [{"label": "A", "text": "Frontal mucocele", "correct": true}, {"label": "B", "text": "Frontal meningioma", "correct": false}, {"label": "C", "text": "Juvenile nasopharyngeal angiofibroma", "correct": false}, {"label": "D", "text": "Pseudotumor of orbit", "correct": false}], "correct_answer": "A. Frontal mucocele", "question_images": ["https://image.prepladder.com/notes/7eFRRdaVEEyNbQ9F8z371745909543.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD with complaints of bleeding from nose, nasal obstruction, and difficulty in breathing. He gave the history of bathing in the local pool near his house. On examination, red polypoidal mass with whitish dots on the surface is observed. Based on the history, examination what will be the diagnosis of the patient?", "options": [{"label": "A", "text": "Rhinosporidiosis", "correct": true}, {"label": "B", "text": "Basal Cell Carcinoma", "correct": false}, {"label": "C", "text": "Rhinoscleroma", "correct": false}, {"label": "D", "text": "Lupus Vulgaris", "correct": false}], "correct_answer": "A. Rhinosporidiosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old women present with upper respiratory tract infection and orbital pain. What is the likely diagnosis?", "options": [{"label": "A", "text": "Orbital cellulitis", "correct": true}, {"label": "B", "text": "Sinusitis", "correct": false}, {"label": "C", "text": "Both A and B", "correct": false}, {"label": "D", "text": "Periosteal abscess", "correct": false}], "correct_answer": "A. Orbital cellulitis", "question_images": ["https://image.prepladder.com/content/GZJQXTnYycmd8rouQ9JF1745912531.png"], "explanation_images": ["https://image.prepladder.com/content/AJVcBrE9b0mzE5lIo63w1744956230.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Orbital Cellulitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orbital <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> is an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <strong>infection of the soft tissues of the orbit</strong> located behind the <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> septum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Exogenous Infection</strong>: Occurs due to <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> injuries. Example: foreign body retention, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> procedures like evisceration, enucleation, orbitotomy, dacryocystectomy.</li>\n<li><strong>Endogenous Infection</strong>: From metastatic infections. Example: breast abscess, puerperal sepsis, thrombophlebitis, septicemia</li>\n<li><strong>Extension from Neighboring Structures</strong> <strong>(most common)</strong>: <span class=\"customMeta\" data-dictid=\"e23ca9914316927771948eba43a1e9\">Paranasal</span> sinuses <strong>(most common: <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> sinus)</strong>, teeth, face, eyelids, <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> cavity, and <span class=\"customMeta\" data-dictid=\"537708a987169277719097ee31f0eb\">intraorbital</span> structures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong>:</p>\n<ul>\n<li>Swelling and severe pain (worsened by eye movement or pressure).</li>\n<li>Systemic symptoms: fever, nausea, vomiting, prostration.</li>\n<li>Vision loss and/or <span class=\"customMeta\" data-dictid=\"1458c330411692777186cd49bb6a30\">diplopia</span> in moderate to advanced cases.</li>\n</ul>\n<p><strong>Signs</strong>:</p>\n<ul>\n<li>Swelling of lids with woody <span class=\"customMeta\" data-dictid=\"80590ff82d169277718875ad69236d\">hardness</span> and redness.</li>\n<li>Chemosis (conjunctival swelling), which may lead to necrosis.</li>\n<li>Axial proptosis.</li>\n<li>Restricted eye movements.</li>\n<li>RAPD (Relative <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">Afferent</span> Pupillary Defect) may occur due to <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> <span class=\"customMeta\" data-dictid=\"2d9476094c16927771933bcb162f19\">neuropathy</span> or central <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> occlusion.</li>\n<li>Fundus examination may show <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> congestion, papillitis, or papilledema</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Modified Chandler staging</strong> system:</p>\n<ul>\n<li>Stage I: <span class=\"customMeta\" data-dictid=\"788578009c1692777196a0a397bdc4\">Preseptal</span> cellulitis/ <span class=\"customMeta\" data-dictid=\"5b1b31d3e41692777195670afc94ca\">periorbital</span> <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> (limited <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> septum)</li>\n<li>Stage II: <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">Inflammatory</span> <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> oedema/ <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> (Posterior to <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> septum)</li>\n<li>Stage III: <span class=\"customMeta\" data-dictid=\"98c8f7f96f1692777199295afb1d35\">Subperiosteal</span> abscess</li>\n<li>Stage IV: <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">Orbital</span> abscess</li>\n<li>Stage V: <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">Cavernous</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> thrombosis</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"497\" src=\"https://image.prepladder.com/content/AJVcBrE9b0mzE5lIo63w1744956230.png\" width=\"679\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cultures</strong>: Nasal, conjunctival, and blood samples for bacterial culture.</li>\n<li><strong>Complete Blood Count</strong>: Leukocytosis.</li>\n<li><strong>X-ray PNS</strong>: To detect sinusitis.\n\t\t\t\t<ul>\n<li><strong>Orbital Ultrasonography</strong>: To detect <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> abscesses.</li>\n</ul>\n</li>\n<li><strong>CT Scan/MRI</strong>: Differentiates <span class=\"customMeta\" data-dictid=\"788578009c1692777196a0a397bdc4\">preseptal</span> from postseptal cellulitis, detects abscesses, <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension, and guides <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> drainage.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old male presented with nasal obstruction. On examination there was an irregular mass protruding from the choanae. What is the possible diagnosis?", "options": [{"label": "A", "text": "Thornwaldt cyst", "correct": false}, {"label": "B", "text": "Antro-choanal polyp", "correct": true}, {"label": "C", "text": "Hypertrophic rhinitis", "correct": false}, {"label": "D", "text": "Adenoid hypertrophy", "correct": false}], "correct_answer": "B. Antro-choanal polyp", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Antro-ch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old patient presenting with non-caseating granulomas and a saddle nose perforation, what is the most likely diagnosis?", "options": [{"label": "A", "text": "TB", "correct": false}, {"label": "B", "text": "Leprosy", "correct": false}, {"label": "C", "text": "Wegener’s granulomatosis", "correct": true}, {"label": "D", "text": "Syphilis", "correct": false}], "correct_answer": "C. Wegener’s granulomatosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Wegener's &lt;span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\"&gt;granulomatosis&lt;/span&gt; (Granulomatosis with Polyangiitis)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A infant developed difficulty in breathing. His symptoms improve with crying. In which disease, symptoms get improve with crying?", "options": [{"label": "A", "text": "Atrophic rhinitis", "correct": false}, {"label": "B", "text": "Acute rhinosinusitis", "correct": false}, {"label": "C", "text": "Allergic rhinitis", "correct": false}, {"label": "D", "text": "Choanal atresia", "correct": true}], "correct_answer": "D. Choanal atresia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\"&gt;Choanal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Water’s view best visualizes which of the following sinuses?", "options": [{"label": "A", "text": "Maxillary sinus", "correct": true}, {"label": "B", "text": "Ethmoidal sinus", "correct": false}, {"label": "C", "text": "Frontal sinus", "correct": false}, {"label": "D", "text": "Sphenoid sinus", "correct": false}], "correct_answer": "A. Maxillary sinus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/us4knwi094HS3ySFAzjG1714392542.png", "https://image.prepladder.com/content/Y5kWv0iImonTni7WUmku1714392806.png"], "explanation": "<p>Correct Option A - Maxillary sinu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the technique shown in the provided image?", "options": [{"label": "A", "text": "Epley’s maneuvre", "correct": false}, {"label": "B", "text": "Trotter’s method", "correct": true}, {"label": "C", "text": "McGovern’s technique", "correct": false}, {"label": "D", "text": "Valsalva maneuvre", "correct": false}], "correct_answer": "B. Trotter’s method", "question_images": ["https://image.prepladder.com/content/A0myYqIinOFCxITFlHHx1691504792.png"], "explanation_images": ["https://image.prepladder.com/content/EktSy7Ulc5jxM6PmmCtd1713443943.png"], "explanation": "<p>Correct Option B - Trotter’s meth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently reported symptom in patients with Nasopharyngeal Carcinoma?", "options": [{"label": "A", "text": "Cervical lymphadenopathy", "correct": true}, {"label": "B", "text": "Hearing Loss", "correct": false}, {"label": "C", "text": "Airway Obstruction", "correct": false}, {"label": "D", "text": "Epistaxis", "correct": false}], "correct_answer": "A. Cervical lymphadenopathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wWKoWnHf1GteR9s6aXDJ1713517379.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\"&gt;Cervical&lt;/span&gt; lymphadenopath\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes Pott’s puffy tumor ?", "options": [{"label": "A", "text": "Subperiosteal abscess of frontal bone", "correct": true}, {"label": "B", "text": "Subperiosteal abscess of ethmoid bone", "correct": false}, {"label": "C", "text": "Mucocele of frontal bone", "correct": false}, {"label": "D", "text": "Mucocele of ethmoid bone", "correct": false}], "correct_answer": "A. Subperiosteal abscess of frontal bone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Subperiosteal &lt;span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\"&gt;abscess&lt;/span&gt; of &lt;span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\"&gt;frontal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mickulicz cells and Russell bodies are characteristically observed in which of the following conditions?", "options": [{"label": "A", "text": "Rhinoscleroma", "correct": true}, {"label": "B", "text": "Rhinosporidiosis", "correct": false}, {"label": "C", "text": "Rhinophyma", "correct": false}, {"label": "D", "text": "Rhinitis", "correct": false}], "correct_answer": "A. Rhinoscleroma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1DNJlRQ1pk6zRTvtBx6u1714042000.png", "https://image.prepladder.com/content/2MA5rTEgzH0b792XD8B41714042084.png"], "explanation": "<p>Correct Option A - Rh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an indication for Young's operation?", "options": [{"label": "A", "text": "Atrophic rhinitis", "correct": true}, {"label": "B", "text": "Vasomotor rhinitis", "correct": false}, {"label": "C", "text": "Antrachoanal polyp", "correct": false}, {"label": "D", "text": "Allergic rhinitis", "correct": false}], "correct_answer": "A. Atrophic rhinitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Atrophic rh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A teenager has a mass in his nasopharynx that has minimally spread into the sphenoid sinus with no lateral extension. Which could be the probable stage of nasopharyngeal angiofibroma?", "options": [{"label": "A", "text": "Stage IA", "correct": false}, {"label": "B", "text": "Stage IB", "correct": true}, {"label": "C", "text": "Stage IIA", "correct": false}, {"label": "D", "text": "Stage IIB", "correct": false}], "correct_answer": "B. Stage IB", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Stage IB\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How would you describe a fracture of the nasal septum that occurs both vertically and horizontally?", "options": [{"label": "A", "text": "Chevallet and Jarjaway fracture", "correct": true}, {"label": "B", "text": "Parade ground fracture", "correct": false}, {"label": "C", "text": "Tripod fracture", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Chevallet and Jarjaway fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hYWb3t7MUicbAFduf1K11714027774.png", "https://image.prepladder.com/content/BczawTd4b0mk4ssWdumu1714027788.png"], "explanation": "<p>Correct Option A - Chevallet and Jarjaway fractu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Jarjavay <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (class 2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chevallet <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (class 1)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direction of blow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontal or fronto-lateral blow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direction of fracture</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Horizontal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/hYWb3t7MUicbAFduf1K11714027774.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/BczawTd4b0mk4ssWdumu1714027788.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nasopharyngeal chordoma arises from which of the following?", "options": [{"label": "A", "text": "Pharyngeal bursa", "correct": false}, {"label": "B", "text": "Notochord", "correct": true}, {"label": "C", "text": "Rathke's pouch", "correct": false}, {"label": "D", "text": "Luschka's bursa", "correct": false}], "correct_answer": "B. Notochord", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Notochord: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed symptom of nasopharyngeal carcinoma?", "options": [{"label": "A", "text": "Airway obstruction", "correct": false}, {"label": "B", "text": "Headache", "correct": false}, {"label": "C", "text": "Neck swelling", "correct": true}, {"label": "D", "text": "Epistaxis", "correct": false}], "correct_answer": "C. Neck swelling", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Neck swelling\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most likely diagnosis in case of continuous watery discharge from the nose following a trauma?", "options": [{"label": "A", "text": "CSF otorrhea", "correct": false}, {"label": "B", "text": "Common colds", "correct": false}, {"label": "C", "text": "CSF rhinorrhea", "correct": true}, {"label": "D", "text": "Anterior epistaxis", "correct": false}], "correct_answer": "C. CSF rhinorrhea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\"&gt;CSF&lt;/span&gt; rhinorrh\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Option</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated with Continuous Watery <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">Discharge</span> from Nose after Trauma?</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A. <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> otorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leakage of <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid from the ear</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B. Common colds</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Viral infection causing <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and runny nose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C. <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> rhinorrhea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Leakage of <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid from the nose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>D. <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> epistaxis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nosebleeds from the front part of the nose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">No</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes a patient who is unable to smell coffee but can smell ammonia after experiencing head trauma?", "options": [{"label": "A", "text": "Ammonia is used for testing olfactory nerve", "correct": false}, {"label": "B", "text": "The olfaction system is not damaged", "correct": false}, {"label": "C", "text": "Ammonia irritates trigeminal nerve", "correct": true}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "C. Ammonia irritates trigeminal nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Ammonia irritates the &lt;span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\"&gt;trigeminal&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following marked structures is a branch of the internal carotid artery ?", "options": [{"label": "A", "text": "1", "correct": true}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "A. 1", "question_images": ["https://image.prepladder.com/content/PbxvvBkPnTj0e9Kq3Q0v1688453223.png"], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your diagnosis for a patient who has a prior history of trauma and is currently experiencing symptoms such as double vision, nosebleeds, and limited eye movements, based on the provided CT image?", "options": [{"label": "A", "text": "Le-fort fracture", "correct": false}, {"label": "B", "text": "Fracture maxilla", "correct": false}, {"label": "C", "text": "Fracture zygomatic", "correct": false}, {"label": "D", "text": "Blow out fracture", "correct": true}], "correct_answer": "D. Blow out fracture", "question_images": ["https://image.prepladder.com/content/ERnK3ccveseBtFqpMK3N1685092649.png"], "explanation_images": ["https://image.prepladder.com/content/HjDBx4AvDamBvxkCvzIw1685092727.png"], "explanation": "<p>Correct Option D - Blow-out fracture: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients with Nasopharyngeal Carcinoma, what is the primary cause of hearing loss?", "options": [{"label": "A", "text": "Metastasis to Temporal Bone", "correct": false}, {"label": "B", "text": "Middle ear Infection", "correct": false}, {"label": "C", "text": "Serous otitis media", "correct": true}, {"label": "D", "text": "Infiltration of Tumour middle ear", "correct": false}], "correct_answer": "C. Serous otitis media", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Serous &lt;span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\"&gt;otitis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 15-year-old male patient who has a nasal mass extending to the cheek, causing one-sided obstruction and occasional nosebleeds?", "options": [{"label": "A", "text": "Angiofibroma", "correct": true}, {"label": "B", "text": "Nasal polyp", "correct": false}, {"label": "C", "text": "Nasopharyngeal Carcinoma", "correct": false}, {"label": "D", "text": "Inverted Papilloma", "correct": false}], "correct_answer": "A. Angiofibroma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the diagnosis for a 30-year-old woman who was involved in a road traffic accident, did not wear a helmet, experienced a brief loss of consciousness, and later presented to the ENT department with complaints of clear fluid discharge from her nose after 2 days?", "options": [{"label": "A", "text": "Allergic rhinitis", "correct": false}, {"label": "B", "text": "Infection due to hemosinus because of RTA", "correct": false}, {"label": "C", "text": "CSF rhinorrhea", "correct": true}, {"label": "D", "text": "Post traumatic rhinitis", "correct": false}], "correct_answer": "C. CSF rhinorrhea", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\"&gt;CSF&lt;/span&gt; rhinorrh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the ideal investigation of choice for confirming CSF rhinorrhea ?", "options": [{"label": "A", "text": "Beta 2 transferrin analysis", "correct": true}, {"label": "B", "text": "CT-cisternogram", "correct": false}, {"label": "C", "text": "Nasal endoscopy", "correct": false}, {"label": "D", "text": "MRI with contrast", "correct": false}], "correct_answer": "A. Beta 2 transferrin analysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\"&gt;Beta&lt;/span&gt; 2 &lt;span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\"&gt;transferrin&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most constant and largest ethmoidal air cells?", "options": [{"label": "A", "text": "Aggar nasi cell", "correct": false}, {"label": "B", "text": "Bulla ethmoidalis", "correct": true}, {"label": "C", "text": "Haller cell", "correct": false}, {"label": "D", "text": "Onodi cell", "correct": false}], "correct_answer": "B. Bulla ethmoidalis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Xf9PMRBCA6nSzvR0V9uM1713526517.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"b221c6ceef16927771838d836a5d3b\"&gt;Bulla&lt;/span&gt; eth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is implicated as the cause of office headaches ?", "options": [{"label": "A", "text": "Maxillary sinusitis", "correct": false}, {"label": "B", "text": "Ethmoid sinusitis", "correct": false}, {"label": "C", "text": "Frontal sinusitis", "correct": true}, {"label": "D", "text": "Sphenoid sinusitis", "correct": false}], "correct_answer": "C. Frontal sinusitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\"&gt;Frontal&lt;/span&gt; sinu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment method that is most commonly recommended for a patient diagnosed with advanced nasopharyngeal carcinoma?", "options": [{"label": "A", "text": "Surgical excision", "correct": false}, {"label": "B", "text": "Radiotherapy", "correct": false}, {"label": "C", "text": "Chemotherapy", "correct": false}, {"label": "D", "text": "Chemoradiotherapy", "correct": true}], "correct_answer": "D. Chemoradiotherapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Chemoradioth\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align: center;\"><strong>T-staging</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T<sub>1</sub></p>\n</td>\n<td>\n<p>Nose/nasopharynx or oropharynx</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T<sub>2</sub></p>\n</td>\n<td>\n<p>Parapharyngeal space</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T<sub>3</sub></p>\n</td>\n<td>\n<p>Skull bone</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>T<sub>4</sub></p>\n</td>\n<td>\n<p>Intra-cranial</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align: center;\"><strong>N-staging</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>N<sub>0</sub></p>\n</td>\n<td>\n<p>No <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> spread</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>N<sub>1</sub></p>\n</td>\n<td>\n<p>&lt; 6 cm : <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>N<sub>2</sub></p>\n</td>\n<td>\n<p>&lt; 6 cm : <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>N<sub>3</sub></p>\n</td>\n<td>\n<p>&gt; 6 cm</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align: center;\"><strong>Metastasis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>M<sub>0</sub></p>\n</td>\n<td>\n<p>No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>M<sub>1</sub></p>\n</td>\n<td>\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Epstein Barr Virus is attributed to the pathogenesis of which of the following?", "options": [{"label": "A", "text": "Juvenile nasopharyngeal angiofibroma", "correct": false}, {"label": "B", "text": "Nasopharyngeal carcinoma", "correct": true}, {"label": "C", "text": "Stewarts granuloma", "correct": false}, {"label": "D", "text": "Rhinoscleroma", "correct": false}], "correct_answer": "B. Nasopharyngeal carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\"&gt;Nasopharyngeal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently reported symptom of Nasopharyngeal Carcinoma?", "options": [{"label": "A", "text": "Nasal obstruction", "correct": false}, {"label": "B", "text": "Epistaxis", "correct": false}, {"label": "C", "text": "Neck node", "correct": true}, {"label": "D", "text": "Anosmia", "correct": false}], "correct_answer": "C. Neck node", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Neck\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 31-year-old presents with complains of tenderness just above the medial canthus. A condition that presents with \"Office headache\". What is the likely diagnosis?", "options": [{"label": "A", "text": "Frontal sinusitis", "correct": true}, {"label": "B", "text": "Maxillary sinusitis", "correct": false}, {"label": "C", "text": "Migraine", "correct": false}, {"label": "D", "text": "Temporal arteritis", "correct": false}], "correct_answer": "A. Frontal sinusitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: Office headach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The frontal sinus can be viewed by taking an X-ray at a specific angle, which is depicted in the image below. What is the name of the view depicted?", "options": [{"label": "A", "text": "Caldwell’s view", "correct": true}, {"label": "B", "text": "Towne’s view", "correct": false}, {"label": "C", "text": "Law’s view", "correct": false}, {"label": "D", "text": "Stenvers view", "correct": false}], "correct_answer": "A. Caldwell’s view", "question_images": ["https://image.prepladder.com/content/d9JBxOtlLCX61oSbJR7c1713509210.png"], "explanation_images": ["https://image.prepladder.com/content/cI71Nd3cB9UjT2n0UZcI1713509232.png", "https://image.prepladder.com/content/TSyJtD0Fb5JseCXOZ1dC1713509247.png"], "explanation": "<p>Correct Option A - Caldwell's v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly diabetic female patient presented with a black, foul-smelling discharge from the nose. On examination, a blackish necrotic mass has filled the nasal cavity and eroded the septum and hard palate. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Aspergillosis", "correct": false}, {"label": "B", "text": "Mucormycosis", "correct": true}, {"label": "C", "text": "Foreign body", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "B. Mucormycosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bsgEx6z539LxQ8W7wwaP1714044774.png"], "explanation": "<p>Correct Option B - Mu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male presents with painless cervical lymphadenopathy and right ear pain. On examination, the right ear reveals conductive hearing loss with a dull tympanic membrane. Moreover, decreased mobility of the soft palate was also noted. What is the probable diagnosis?", "options": [{"label": "A", "text": "Nasopharyngeal carcinoma", "correct": true}, {"label": "B", "text": "Adenoid cystic cancer", "correct": false}, {"label": "C", "text": "Juvenile nasopharyngeal angiofibroma", "correct": false}, {"label": "D", "text": "Quinsy", "correct": false}], "correct_answer": "A. Nasopharyngeal carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\"&gt;Nasopharyngeal&lt;/span&gt; C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which fungal infection is frequently observed in the maxillary sinus?", "options": [{"label": "A", "text": "Blastomycosis", "correct": false}, {"label": "B", "text": "Aspergillosis", "correct": true}, {"label": "C", "text": "Candidiasis", "correct": false}, {"label": "D", "text": "Histoplasmosis", "correct": false}], "correct_answer": "B. Aspergillosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Asperg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 105 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 13 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 35-year-old woman complains of ongoing nasal congestion and sneezing through out the year. She lives with two cats and works in an environment with mould exposure. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Seasonal allergic rhinitis", "correct": false}, {"label": "B", "text": "Non-allergic rhinitis", "correct": false}, {"label": "C", "text": "Perennial allergic rhinitis", "correct": true}, {"label": "D", "text": "Allergic asthma", "correct": false}], "correct_answer": "C. Perennial allergic rhinitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Qqnq3bxXwLqYocmZKyRb1738609631.png", "https://image.prepladder.com/content/aghJC7H9SGAxsjtAPfOj1738609666.png", "https://image.prepladder.com/content/1C7ptQjFPEueaDbFFMM41738609698.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/9I1fhIEzUndiMazO2GzH1745345210.mp3", "video": ""}, {"text": "Which of the following signs is commonly observed in individuals who frequently rub their face to alleviate itching caused by allergic reactions?", "options": [{"label": "A", "text": "Granular pharyngitis", "correct": false}, {"label": "B", "text": "Erythematous conjunctiva", "correct": false}, {"label": "C", "text": "Allergic shiners", "correct": false}, {"label": "D", "text": "Allergic salute", "correct": true}], "correct_answer": "D. Allergic salute", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OiOajrJnXrWoO2KYOcoj1738609761.png", "https://image.prepladder.com/content/1UXbRoR5vaOkwCL9VS4G1738609839.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Allergic Rhinitis</strong></h3>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h3><strong>Symptoms </strong></h3>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Signs</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Watery <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Discharge.</li>\n<li>Nasal Obstruction</li>\n<li>Sneezing</li>\n<li>Nasal Itching</li>\n<li>Itching in the Eyes, Palate, and Pharynx</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Nasal Signs:</u>\n<ul>\n<li>Transverse <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Crease</li>\n<li>Pale and Swollen <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Mucosa</li>\n<li>Swollen Turbinates</li>\n</ul>\n</li>\n<li><u>Ocular Signs:</u>\n<ul>\n<li>Eyelid Swelling</li>\n<li>Conjunctival <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">Congestion</span> (Cobble-stone appearance), associated with VKC</li>\n<li>Dark Circles ('Allergic Shiners')</li>\n</ul>\n</li>\n<li><u>Otologic Signs:</u>\n<ul>\n<li>Retracted <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">Tympanic</span> Membrane</li>\n<li>Serous <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> Media</li>\n</ul>\n</li>\n<li><u>Pharyngeal Signs:</u> <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">Granular</span> Pharyngitis</li>\n<li><u>Laryngeal Signs:</u>\n<ul>\n<li>Hoarseness</li>\n<li>Laryngeal Oedema</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0p8qfyhc7v71HZN3DzVT1745345431.mp3", "video": ""}, {"text": "Which test is frequently utilised to identify the precise allergens responsible for allergic rhinitis symptoms?", "options": [{"label": "A", "text": "Nasal smear", "correct": false}, {"label": "B", "text": "Skin Prick Test", "correct": true}, {"label": "C", "text": "Complete Blood Count", "correct": false}, {"label": "D", "text": "Serum IgE", "correct": false}], "correct_answer": "B. Skin Prick Test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BHMrApn5oJnwP59PlJKu1738609930.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Vd5Hw8swRbO1CLGSM8W81746079409.mp3", "video": ""}, {"text": "A 25 y/o male with a history of perennial allergic rhinitis presents with persistent nasal obstruction despite regular use of oral antihistamines. He has tried several medications without significant improvement. What would be the next best step in managing this patient?", "options": [{"label": "A", "text": "Add intranasal corticosteroids", "correct": true}, {"label": "B", "text": "Start a short course of oral corticosteroids", "correct": false}, {"label": "C", "text": "Begin immunotherapy", "correct": false}, {"label": "D", "text": "Use intranasal ipratropium bromide", "correct": false}], "correct_answer": "A. Add intranasal corticosteroids", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:602px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Allergen Avoidance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Avoidance of identified allergens. Remove pets, encase bedding, and change diet</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most effective but not always practical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Drug Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Antihistamines</u>: Controls rhinorrhoea, sneezing, and itching. Diphenhydramine, Cetirizine</li>\n<li><u>Sympathomimetics</u>: Reduces <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> congestion. Pseudoephedrine, Phenylephrine</li>\n<li><u>Corticosteroids</u>: For <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> episodes. Prednisone</li>\n<li><u>Sodium Cromoglycate</u>: Stabilises <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells. <span class=\"customMeta\" data-dictid=\"d3f7cd4f92169277718588c69a0f10\">Cromolyn</span> sodium</li>\n<li><u>Anticholinergics:</u> Blocks rhinorrhoea. Eg. Ipratropium bromide</li>\n<li><u>Leukotriene <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Antagonists:</u> Montelukast</li>\n<li><u>Anti-IgE:</u> Omalizumab</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Drowsiness with antihistamines;</li>\n<li>limited use of corticosteroids due to side effects</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Immunotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gradually increasing doses of allergens to suppress <span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\">IgE</span> formation and boost IgG.</li>\n<li>Allergen-specific injections or <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> tablets</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Used when drug therapy is ineffective or not tolerated</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disease Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Options</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Mild <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">Intermittent</span> Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral antihistamines, <span class=\"customMeta\" data-dictid=\"7ce016ff5116927771905364aaefee\">intranasal</span> <span class=\"customMeta\" data-dictid=\"d3f7cd4f92169277718588c69a0f10\">cromolyn</span> sodium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Moderate Severity/Persistent Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intranasal corticosteroids</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severe Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oral non-sedating antihistamines + <span class=\"customMeta\" data-dictid=\"7ce016ff5116927771905364aaefee\">intranasal</span> steroids</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Severe Persistent Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short course oral steroids + immunotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Persistent <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Short course intranasal/oral decongestants (with antihistamines for oral)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tpGcWb0XlCvlQ2YcR9lO1745346073.mp3", "video": ""}, {"text": "A 45 y/o woman with a long-standing history of non-allergic rhinitis presents with persistent nasal obstruction and rhinorrhoea that has not responded to antihistamines and nasal steroid sprays. Which of the following would be the next best step in managing her condition?", "options": [{"label": "A", "text": "Increase the dose of topical steroid sprays", "correct": false}, {"label": "B", "text": "Start systemic steroids for a short period and add ipratropium bromide nasal spray", "correct": true}, {"label": "C", "text": "Vidian neurectomy", "correct": false}, {"label": "D", "text": "Psychological support and tranquillisers", "correct": false}], "correct_answer": "B. Start systemic steroids for a short period and add ipratropium bromide nasal spray", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Lifestyle Modifications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Avoid triggers such as sudden temperature changes, humidity, air blasts, and dust.</li>\n<li>Practical changes to minimise symptom triggers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pharmacological Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><u>Antihistamines and Decongestants:</u> Alleviate <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction, sneezing, and rhinorrhoea.</li>\n<li><u>Topical <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">Steroid</span> Sprays:</u> Control Symptoms. Eg. Beclomethasone dipropionate, budesonide, fluticasone</li>\n<li><u>Systemic Steroids:</u> Used for severe cases for a short time</li>\n<li><u>Ipratropium <span class=\"customMeta\" data-dictid=\"749f9a02041692777183f4f13efcc5\">Bromide</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Spray:</u> Effective for Excessive Rhinorrhoea.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Psychological Support</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Address emotional factors; consider counselling and tranquillisers.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples/Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Turbinate Reduction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> by shrinking <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> size; also corrects other obstructions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Submucosal diathermy, resection, cryosurgery, turbinectomy, cauterisation, laser, coblation, radiofrequency.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vidian Neurectomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Considered for persistent excessive rhinorrhoea despite medical therapy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It involves sectioning <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> <span class=\"customMeta\" data-dictid=\"591ff46f251692777198992363d6f3\">secretomotor</span> fibres to the nose.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6iYE8Pd6WsVbP6m1T0cb1746079618.mp3", "video": ""}, {"text": "A 16 y/o girl presents with a foul-smelling nasal discharge, nasal obstruction, and anosmia. She has noticeable atrophy of the nasal turbinates and pale nasal mucosa. O/E the nasal chambers are enlarged and roomy. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Secondary atrophic rhinitis.", "correct": false}, {"label": "B", "text": "Vasomotor rhinitis.", "correct": false}, {"label": "C", "text": "Primary atrophic rhinitis.", "correct": true}, {"label": "D", "text": "Rhinitis sicca.", "correct": false}], "correct_answer": "C. Primary atrophic rhinitis.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Heredity</li>\n<li>Endocrine disturbance</li>\n<li>Racial factors</li>\n<li>Nutritional deficiency</li>\n<li><strong>Infective: <span class=\"customMeta\" data-dictid=\"50f3c6e8dd16927771902c55d555b8\">Klebsiella</span> ozaenae </strong></li>\n<li>Autoimmune</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n<p style=\"text-align: center;\"><strong>And Examination findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primarily affects females, starts around puberty</li>\n<li>Foul-smelling <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge; patients are usually unaware of it themselves and have <span class=\"customMeta\" data-dictid=\"cc8a35010816927771819ba9cf19d8\">anosmia</span> (merciful anosmia).</li>\n<li>Paradoxical <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> despite enlarged <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> chambers.</li>\n<li>Epistaxis from <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">crust</span> removal.</li>\n<li>Pale <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> mucosa, <span class=\"customMeta\" data-dictid=\"ae1132b13e1692777182aec918eee0\">atrophied</span> turbinates, potential septal perforation, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"586f3a8b251692777201914716d12e\">vestibule</span> dermatitis, <span class=\"customMeta\" data-dictid=\"8b3b29ae5516927771987d1b16beb1\">saddle</span> nose deformity.</li>\n<li>Possible extension to <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">pharynx</span> and <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> leading to <span class=\"customMeta\" data-dictid=\"65b19c9ce61692777182e7b765acf0\">atrophic pharyngitis</span> and laryngitis.</li>\n<li>Eustachian tube <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> cause hearing impairment.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Specific infections: Syphilis, lupus, leprosy, rhinoscleroma</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> sinusitis</li>\n<li>Radiation therapy: To nose and sinuses</li>\n<li>Excessive <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> removal surgery: Empty nose syndrome</li>\n<li>Extreme septal deviation: Causing <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"060dfc2c2716927771824a7a055ed1\">atrophic rhinitis</span> on wider side</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Similar to primary atrophic rhinitis</li>\n<li>Presence of features related to underlying cause (e.g., syphilis, lupus)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/bInAVJQc9i3JFo8UUsoP1746081591.mp3", "video": ""}, {"text": "A 45-year-old patient presents with persistent nasal crusting and foul odour, unresponsive to medical treatment. Which procedure narrows the nasal cavity to reduce crusting?", "options": [{"label": "A", "text": "Young's operation", "correct": false}, {"label": "B", "text": "Use of 25% glucose in glycerine nasal application", "correct": false}, {"label": "C", "text": "Nasal irrigation with an alkaline solution", "correct": false}, {"label": "D", "text": "Lautenschlaeger technique", "correct": true}], "correct_answer": "D. Lautenschlaeger technique", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Nasal <span class=\"customMeta\" data-dictid=\"ea6a429a6b1692777190801502ba55\">Irrigation</span> and <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">Crust</span> Removal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Use warm <span class=\"customMeta\" data-dictid=\"ab6984f43316927771937ff19f3807\">normal saline</span> or an <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> solution for <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> irrigation.</li>\n<li>Irrigate multiple times daily initially, reducing to once every 2-3 days as symptoms improve.</li>\n<li>For stubborn crusts, use glucose-glycerin solution before removal with <span class=\"customMeta\" data-dictid=\"c01b366a9c1692777203ef77069d2c\">forceps</span> or suction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Topical Applications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Apply 25% <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> in glycerine to <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> <span class=\"customMeta\" data-dictid=\"f8440ebdc11692777196443e066978\">proteolytic</span> bacteria growth, reducing foul smell.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic antibiotics (e.g., fluoroquinolones with metronidazole) for 7-10 days.</li>\n<li>Long-term use is not recommended.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Other Therapies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mucolytics: <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> <span class=\"customMeta\" data-dictid=\"7fa62c89591692777190c3b9e60490\">iodide</span> solutions to <span class=\"customMeta\" data-dictid=\"ce713b13a616927771910ed3727436\">liquefy</span> secretions.</li>\n<li>Experimental: Oestradiol <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> sprays and <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"387ff6837a16927771876363756d5a\">extract</span> injections have been explored.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Dietary Recommendations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"3ab0d6410a1692777182a1727e39c0\">balanced diet</span> rich in vitamins A, D, folic acid, iron, and protein to support overall health and mucosal recovery.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Young's Operation and Modifications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Complete <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of both nostrils in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> vestibule.</li>\n<li>Reopen nostrils after approximately 6 months to encourage mucosal <span class=\"customMeta\" data-dictid=\"91229d427e169277719753f25af9f0\">regeneration</span> and reduce crusting.</li>\n<li>Modified versions partially close nostrils to reduce discomfort while aiming for similar benefits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Techniques to narrow excessively wide <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> chambers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Autologous grafts (fat, cartilage, bone) placed under the <span class=\"customMeta\" data-dictid=\"19c216fc681692777193078a2283b5\">mucoperiosteum</span> of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> floor/lateral walls or <span class=\"customMeta\" data-dictid=\"40cd924b071692777193d447a5382c\">mucoperichondrium</span> of septum.</li>\n<li>Allografts (Alloderm, Cymetra) can be used.</li>\n<li>The <strong>Lautenschlaeger technique</strong> involves <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> wall to narrow <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavities which can help reduce crusting by improving <span class=\"customMeta\" data-dictid=\"99caf903791692777180bc28743310\">airflow</span> and humidifying the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages.<strong> (Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CI0tomzl6IWSLz2PEMdx1746082120.mp3", "video": ""}, {"text": "A 45 y/o goldsmith reports persistent nasal crusting in bilateral nostrils in the anterior part . He has occasional nosebleeds and his nasal septum appears eroded. Which of the following is the most likely diagnosis for this patient’s symptoms?", "options": [{"label": "A", "text": "Rhinitis Sicca", "correct": true}, {"label": "B", "text": "Rhinitis Caseosa", "correct": false}, {"label": "C", "text": "Chronic sinusitis", "correct": false}, {"label": "D", "text": "Allergic rhinitis", "correct": false}], "correct_answer": "A. Rhinitis Sicca", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:582px\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Rhinitis Sicca</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Rhinitis Caseosa</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects individuals working in hot, dry, dusty environments (e.g., bakers, ironsmiths, goldsmiths)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uncommon, typically affects males, usually unilateral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confined to the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> third of the nose, especially the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Originates from sinuses affecting the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> unilaterally</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ciliated <span class=\"customMeta\" data-dictid=\"8ff554096316927771851cc310435e\">columnar epithelium</span> undergoes <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"cb4dfcbab11692777192d282b3be7a\">metaplasia</span> with <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of sero-mucinous glands.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"3207c2541a1692777198f4af88308b\">sinusitis</span> with <span class=\"customMeta\" data-dictid=\"11d92ee2d916927771907f5dfc40d1\">inspissated</span> <span class=\"customMeta\" data-dictid=\"a8afeac6af16927771840f4ef2c30d\">cheesy</span> material; <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> becomes granulomatous.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crust formation, ulceration, epistaxis, and possible septal <span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\">perforation</span> due to <span class=\"customMeta\" data-dictid=\"62b976e2941692777185c4b2eb180b\">crust</span> removal.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nose filled with offensive <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> and <span class=\"customMeta\" data-dictid=\"a8afeac6af16927771840f4ef2c30d\">cheesy</span> material.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> of the <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> becomes granulomatous.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Improve occupational surroundings</li>\n<li>Apply <span class=\"customMeta\" data-dictid=\"862b9b46641692777183ea602de834\">bland</span> or antibiotic/steroid ointment.</li>\n<li>Avoid nose picking/removal of crusts.</li>\n<li>Use <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> douche.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Removal of debris, and <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, and ensuring free <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of the affected sinus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/o9dTUhaJMqh0cErF7sJr1746539422.mp3", "video": ""}, {"text": "A 32 y/o patient presents with clear nasal discharge that has been persistent for the past week, worsening after a recent head injury from a fall. The discharge is occasionally mixed with blood and is more prominent when bending forward. Which of the following is the most likely common site of CSF leakage in this patient?", "options": [{"label": "A", "text": "Roof of the ethmoid air cells", "correct": false}, {"label": "B", "text": "Cribriform plate", "correct": true}, {"label": "C", "text": "Frontal sinus", "correct": false}, {"label": "D", "text": "Sphenoid sinus", "correct": false}], "correct_answer": "B. Cribriform plate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anterior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Middle <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> fossa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Temporal bone fracture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cribriform plate(most common)</strong></li>\n<li>Roof of <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> air cells</li>\n<li>Frontal sinus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphenoid sinus(following trauma)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CSF reaches the middle ear, escaping through the <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube into the nose (CSF otorhinorrhea)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/gr9KL9Qm9fsW87jOu9wW1746540425.mp3", "video": ""}, {"text": "A patient presents with a clear, watery nasal discharge. The patient has a history of head injury. Which of the following characteristics would best differentiate this condition from simple rhinorrhea?", "options": [{"label": "A", "text": "Presence of a continuous discharge that can be sniffed back.", "correct": false}, {"label": "B", "text": "Discharge with a salty taste and lower sugar content.", "correct": false}, {"label": "C", "text": "Presence of Beta-2 transferrin and high sugar content in the fluid.", "correct": true}, {"label": "D", "text": "Discharge that causes the handkerchief to stiffen.", "correct": false}], "correct_answer": "C. Presence of Beta-2 transferrin and high sugar content in the fluid.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RdHOrDKpOrCbPNjDRnsq1738610075.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CSF rhinorrhea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Simple rhinorrhea</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nasal or <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> surgery</li>\n<li>Head injury</li>\n<li>Intracranial tumour</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sneezing</li>\n<li>Nasal stuffiness.</li>\n<li>Itching in the nose/lacrimation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flow of discharge</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A few drops or a stream of fluid gushes down when bending forward or straining, cannot be sniffed back.<strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Continuous, no effect of bending forwards or straining, can be sniffed back</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Character of discharge</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thin, watery and clear.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually slimy (mucous).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Taste</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sweet <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Salty</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sugar content</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More than 30gm/dl</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than 10mg/dl</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of Beta-2 Transferrin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Always present, specific for CSF.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Always absent.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rbNP1RrTvtpWrsF6WQ4i1746540711.mp3", "video": ""}, {"text": "A 50-year-old woman presents with clear, watery nasal discharge that increases when she bends forward. She denies any history of allergies and reports having undergone nasal surgery a few weeks ago. Which biochemical test is the most appropriate to confirm the diagnosis in this patient?", "options": [{"label": "A", "text": "Glucose oxidase test", "correct": false}, {"label": "B", "text": "Beta-2 transferrin test", "correct": true}, {"label": "C", "text": "Sniff test", "correct": false}, {"label": "D", "text": "Lactate dehydrogenase (LDH) test", "correct": false}], "correct_answer": "B. Beta-2 transferrin test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glucose estimation test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta-2 <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">Transferrin</span> test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Beta trace protein test</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid but unreliable test using <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> paper.</li>\n<li>Not specific for the site or side of the leak.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A protein unique to CSF, not found in <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> discharge.</li>\n<li>Its presence is a specific and sensitive test for CSF rhinorrhea.</li>\n<li>Requires only a few drops of CSF for testing.</li>\n<li>Found in CSF, perilymph, and <span class=\"customMeta\" data-dictid=\"0f0067663b16927771818fe253b3b9\">aqueous</span> humor.</li>\n<li>The best test for confirming CSF in <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> fluid, but doesn’t localize the leak.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Another protein-specific test to detect CSF.</li>\n<li>Secreted by the <span class=\"customMeta\" data-dictid=\"f171f7433d1692777192c344425c41\">meninges</span> and <span class=\"customMeta\" data-dictid=\"87b317afbd16927771844e0e534940\">choroid</span> plexus.</li>\n<li>Also known as <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> D synthase.</li>\n<li>High sensitivity and specificity.</li>\n<li>Present in other tissues (testes, heart) and altered in conditions like <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure and CNS diseases.</li>\n<li>But, facilities to test these are not easily available. <strong>(Option D)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/D8aQKokoiVbVKfZg6j6w1746542848.mp3", "video": ""}, {"text": "A 45-year-old male presents with a clear, watery nasal discharge that worsens when bending forward. He has a history of recent head trauma. Examination shows no signs of infection or sinusitis. Which of the following is the most appropriate initial imaging modality for diagnosing the cause of his symptoms?", "options": [{"label": "A", "text": "MRI", "correct": false}, {"label": "B", "text": "High-Resolution CT (HRCT)", "correct": true}, {"label": "C", "text": "CT Cisternography", "correct": false}, {"label": "D", "text": "X-ray of the skull", "correct": false}], "correct_answer": "B. High-Resolution CT (HRCT)", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High-Resolution CT(HRCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice</strong> for identifying skull base defects.</li>\n<li>3D <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> helps evaluate <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> or <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> defects.</li>\n<li>Useful for detecting trauma, developmental abnormalities, or <span class=\"customMeta\" data-dictid=\"d6ccfc448916927771877d9bde179f\">erosive</span> lesions.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Cisternography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Involves <span class=\"customMeta\" data-dictid=\"02d3150bf71692777190d8129891c2\">intrathecal</span> contrast <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> to localize the <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> leak.</li>\n<li>Improves <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> yield, especially in active leaks.</li>\n<li>May miss <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> or <span class=\"customMeta\" data-dictid=\"77d6d0146716927771877b0c93c24f\">ethmoid</span> <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> defects.</li>\n<li>Invasive procedure with potential side effects like <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and headaches.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>MRI </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Not first-line unless <span class=\"customMeta\" data-dictid=\"78667b98371692777187bf2214c9b5\">encephalocele</span> is suspected.</li>\n<li>Less effective for identifying bony defects compared to CT.</li>\n<li>More costly and time-consuming; and may require a contrast agent.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wdMBwjgzJlzMJviEI3xM1746543009.mp3", "video": ""}, {"text": "A 42 y/o male presents with a history of persistent nasal discharge following a recent head trauma. He reports clear, watery fluid leaking from his nose which tests positive for beta-2 transferrin. After initial conservative management, the patient’s symptoms persist. HRCT shows injury to the cribriform plate. Which of the following is the most appropriate next step in the surgical management of this patient?", "options": [{"label": "A", "text": "External ethmoidectomy", "correct": false}, {"label": "B", "text": "Transnasal endoscopic repair", "correct": true}, {"label": "C", "text": "Osteoplastic flap and sinus obliteration", "correct": false}, {"label": "D", "text": "Lumbar drain", "correct": false}], "correct_answer": "B. Transnasal endoscopic repair", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fdhFuFgp6WsHTI5KH49y1746543145.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 23 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 14 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 7-year-old child presents with chronic nasal obstruction, snoring, and mouth breathing. Physical examination reveals characteristic facial appearance as shown in the image and hypertrophy of the nasal turbinates. What is the most appropriate diagnostic test to confirm the suspected condition?", "options": [{"label": "A", "text": "posterior rhinoscopy", "correct": false}, {"label": "B", "text": "Nasal endoscopy", "correct": true}, {"label": "C", "text": "Anterior Rhinoscopy", "correct": false}, {"label": "D", "text": "CT Scan of the Nasopharynx", "correct": false}], "correct_answer": "B. Nasal endoscopy", "question_images": ["https://image.prepladder.com/content/rEH3R2gmt8k7n8EoJVUN1738608583.png"], "explanation_images": ["https://image.prepladder.com/content/BrqXgEFeHDRS1MG0xQHl1738608656.png", "https://image.prepladder.com/content/ta7U1QDZm2OKXWX5pboJ1738608680.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adenoid Hypertrophy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Physiological Enlargement:</strong> Common in childhood.</li>\n<li><strong>Chronic Conditions:</strong> <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> rhinitis, sinusitis, chronic tonsillitis, &amp; allergies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nasal Symptoms:</strong>\n<ul>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> leading to <span class=\"customMeta\" data-dictid=\"491e4d8d3f1692777192a47674360b\">mouth breathing</span> and <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties.</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> due to <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and chronic rhinitis.</li>\n<li>Sinusitis, <span class=\"customMeta\" data-dictid=\"26bb4e3cc81692777187ce44e530e5\">Epistaxis</span> &amp; voice changes due to <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction. <strong>(Rhinolalia clausa)</strong></li>\n</ul>\n</li>\n<li><strong>Aural Symptoms:</strong>\n<ul>\n<li>Tubal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> causing retracted <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and CHL.</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media and chronic <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media.</li>\n<li>Otitis media with <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> due to <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube obstruction.</li>\n</ul>\n</li>\n<li><strong>Adenoid Facies:</strong> Characteristic <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> appearance with an <strong>elongated face, open mouth, crowded upper teeth, and high-arched palate.</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"516\" src=\"https://image.prepladder.com/content/BrqXgEFeHDRS1MG0xQHl1738608656.png\" width=\"400\"/></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Luv AgarwalRagni TandonR. KulshresthaAnkita Gupta\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Photograph-of-a-patient-with-adenoids-showing-open-mouth-breathing-and-expression-less_fig1_276490718\" data-tags=\"\" height=\"502\" src=\"https://image.prepladder.com/content/ta7U1QDZm2OKXWX5pboJ1738608680.png\" width=\"400\"/></p>\n<ul>\n<li><strong>Pulmonary Hypertension:</strong> Potential due to long-standing <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction.</li>\n<li><strong>Aprosexia:</strong> Difficulty concentrating</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>External Nose:</strong> Check for skin changes indicating frequent nose rubbing.</li>\n<li><strong>Nasal Assessment: </strong>Halogen light <span class=\"customMeta\" data-dictid=\"286d894b461692777194849ba2b56d\">otoscope</span> is used for simple <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"309340c557169277719733005c01d5\">rhinoscopy</span> <strong>(Option C), </strong>which examines the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> but not the adenoids.</li>\n<li><strong>Adenoid Assessment:</strong>\n<ul>\n<li><strong>Nasendoscopy:</strong> For detailed evaluation, a flexible <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> <span class=\"customMeta\" data-dictid=\"e3a3b038c216927771875644f31cc5\">endoscope</span> with <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> anaesthesia is preferred. It provides<strong> an accurate assessment of <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> size in an <span class=\"customMeta\" data-dictid=\"a9f32a257d1692777194caf3b4cf78\">outpatient</span> setting.</strong></li>\n<li><strong>Lateral Soft-Tissue <span class=\"customMeta\" data-dictid=\"5c71603ac81692777197e2aa1e7fd3\">Radiograph</span> </strong><strong>(Option B)</strong><strong>:</strong> This is useful when <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> is not tolerated; it correlates well with <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> findings.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/FkxE3lgmemAIfMIYQxSB1744823618.mp3", "video": ""}, {"text": "An 8-year-old child presents with chronic nasal obstruction and recurrent otitis media. The physician performs endoscopy to evaluate adenoid hypertrophy. The endoscopic finding is given in the image. What is the grade of adenoid hypertrophy?", "options": [{"label": "A", "text": "Grade I", "correct": false}, {"label": "B", "text": "Grade II", "correct": false}, {"label": "C", "text": "Grade III", "correct": true}, {"label": "D", "text": "Grade IV", "correct": false}], "correct_answer": "C. Grade III", "question_images": ["https://image.prepladder.com/content/KjtAqL4NkQQSH4sS6Fwn1738608891.png"], "explanation_images": ["https://image.prepladder.com/notes/IVbjO9nYiGPIOsyycyI91746086721.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pijYRXqybbhhPhTsi3591748000035.mp3", "video": ""}, {"text": "A 6-year-old child with persistent nasal obstruction and recurrent ear infections has not improved with decongestants and antihistamines. What is the most appropriate next step for definitive management currently being used?", "options": [{"label": "A", "text": "Curettage", "correct": false}, {"label": "B", "text": "Endoscopic adenoidectomy", "correct": true}, {"label": "C", "text": "Nasal Steroids", "correct": false}, {"label": "D", "text": "Observation", "correct": false}], "correct_answer": "B. Endoscopic adenoidectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:660px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">Adenoid</span> Hypertrophy:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Management: (For Mild Cases initially)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breathing exercises</li>\n<li>Decongestant <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> drops</li>\n<li>Antihistamines for any <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> allergies</li>\n<li>Topical <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Steroids <strong>(Option C)</strong> may reduce <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> size and improve related symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Intervention: </strong><strong>(Adenoidectomy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Traditional Methods: Blind <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> adenoidectomy</strong> <strong>(Option A) </strong>remains common, but it has disadvantages, including unpredictable <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and poor access to the <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> adenoid. Hence, <strong>Endoscopic management</strong> is currently preferred.</li>\n<li><strong>Direct Vision Techniques:</strong>\n<ul>\n<li><strong>Suction Diathermy</strong></li>\n<li><strong>Endoscopic Coblation/Microdebridement </strong><strong>(Option B) involves using <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> to visualise and</strong> allows for precise removal of obstructive <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> tissue, addressing the underlying issue directly.</li>\n<li><strong>KTP Laser:</strong> Associated with a higher risk of <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> stenosis, while the gold laser has not shown this risk.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/z9U6LcudlkISIhLqmi1i1744857908.mp3", "video": ""}, {"text": "A 9-year-old child was scheduled for elective adenoidectomy but developed an acute upper respiratory infection the day before the surgery. The child has no cleft palate or bleeding disorders. What is the most appropriate next step?", "options": [{"label": "A", "text": "Proceed with adenoidectomy as planned", "correct": false}, {"label": "B", "text": "Delay the surgery until the infection resolves", "correct": true}, {"label": "C", "text": "Start antibiotics and proceed with surgery", "correct": false}, {"label": "D", "text": "Discharge the patient with medical management", "correct": false}], "correct_answer": "B. Delay the surgery until the infection resolves", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications &amp; Contraindications of Adenoidectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Adenoid <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> causing snoring, mouth breathing, sleep apnea, or speech abnormalities (rhinolalia clausa).</li>\n<li>Recurrent rhinosinusitis.</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media with <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> hyperplasia.</li>\n<li>Recurrent ear <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> in <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> CSOM associated with adenoiditis.</li>\n<li>Preventing <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> of <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> <span class=\"customMeta\" data-dictid=\"0438d07b72169277719118c1a60861\">malocclusion</span> after orthodontic treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cleft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> or <span class=\"customMeta\" data-dictid=\"b49bba8e8a16927771997b281fd66a\">submucous</span> <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> (risk of <span class=\"customMeta\" data-dictid=\"35a7cfc3341692777201b27c58dc6d\">velopharyngeal</span> insufficiency).</li>\n<li>Hemorrhagic diathesis.</li>\n<li><strong>Acute upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infection.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pJA9dWz9dY6a45QF54Fv1744860010.mp3", "video": ""}, {"text": "A 6-year-old child undergoes an adenoidectomy. Following the surgery, the child is monitored for potential complications. Which of the following is not a recognised complication of adenoidectomy?", "options": [{"label": "A", "text": "Velopharyngeal Insufficiency", "correct": false}, {"label": "B", "text": "Grisel’s Syndrome", "correct": false}, {"label": "C", "text": "Chronic Otitis Media", "correct": true}, {"label": "D", "text": "Injury to Eustachian tube", "correct": false}], "correct_answer": "C. Chronic Otitis Media", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adenoidectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anesthesia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General with oral <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> intubation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Position</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rose’s position.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Preparation</strong>: Insert Boyle-Davis mouth gag. Examine the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> with a tongue <span class=\"customMeta\" data-dictid=\"afa1c10cd41692777186d701d9fe79\">depressor</span> and digital palpation.</li>\n<li><strong>Adenoid Removal</strong>: Use a <span class=\"customMeta\" data-dictid=\"b0959c0d281692777185c263be8d4e\">curette</span> with a guard to engage and remove adenoids. <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> masses are removed with smaller curettes, and any remaining tissue is extracted with punch forceps.</li>\n<li><strong>Hemostasis</strong>: Achieved by <span class=\"customMeta\" data-dictid=\"80273d93491692777194321d2f821b\">packing</span> the area. Persistent <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> may require <span class=\"customMeta\" data-dictid=\"418070340b16927771875ee13ba78c\">electrocoagulation</span> or a <span class=\"customMeta\" data-dictid=\"785b6d19ba16927771965c071acb28\">postnasal</span> pack for 24 hours.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endoscopic Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Debrider</strong>: For precise removal under <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> control.</li>\n<li><strong>Coblation</strong>: Uses <span class=\"customMeta\" data-dictid=\"07f73f8986169277719716f3a62e1b\">radiofrequency</span> to create a <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> field for removal.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/C5WKzD7VObCEHQbNtqzz1744860328.mp3", "video": ""}, {"text": "A 45-year-old patient presents with chronic nasopharyngeal discomfort and intermittent nasal obstruction. Imaging studies reveal a midline cystic structure in the nasopharynx. The patient is diagnosed with Thornwaldt's disease. Which of the following anatomical remnants is most likely associated with this condition?", "options": [{"label": "A", "text": "Remnant of Rathke’s pouch", "correct": false}, {"label": "B", "text": "Remnant of the pharyngeal cleft", "correct": false}, {"label": "C", "text": "Remnant of the notochord", "correct": true}, {"label": "D", "text": "Persistence of the thyroglossal duct", "correct": false}], "correct_answer": "C. Remnant of the notochord", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gUXPDzqGgn3bfsHGt9w81738639885.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/eSJw8e0LPeI34tHstthX1744874378.mp3", "video": ""}, {"text": "A 10-year-old child presents with a sore throat, difficulty swallowing, and a fever. On examination, the child has enlarged tonsils with visible crypts. Which of the following anatomical features of the palatine tonsils is not true?", "options": [{"label": "A", "text": "They are covered by stratified squamous epithelium with crypts.", "correct": false}, {"label": "B", "text": "They receive blood mainly from the tonsillar branch of the facial artery.", "correct": false}, {"label": "C", "text": "A fibrous capsule with loose areolar tissue covers the lateral surface.", "correct": false}, {"label": "D", "text": "Lymphatic drainage primarily involves the lower deep cervical nodes.", "correct": true}], "correct_answer": "D. Lymphatic drainage primarily involves the lower deep cervical nodes.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/77mdCd5QeeJxok0u1s011738639993.png", "https://image.prepladder.com/content/UCAtmAeNjFpMYvpEhvAB1738640023.png", "https://image.prepladder.com/content/Vyh6LSVUq2X7UHZ4Wrzr1738640045.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomy of <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">Palatine</span> tonsils</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral wall of the <span class=\"customMeta\" data-dictid=\"4356afe522169277719436b593e4b1\">oropharynx</span> between the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pillars.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surface Extensions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upwards into the soft palate, downwards into the base of the tongue, and anteriorly into the <span class=\"customMeta\" data-dictid=\"e9ece0007c1692777194ca3031b229\">palatoglossal</span> arch.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medial Surface Epithelium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Stratified <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> with crypts. </strong><strong>(Option A)</strong></li>\n<li>Crypta magna, or <span class=\"customMeta\" data-dictid=\"d567f07dd1169277719021eebd8d64\">intratonsillar</span> cleft, is located near the upper part of the tonsil.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/77mdCd5QeeJxok0u1s011738639993.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral Surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is covered by a <strong>fibrous <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> separated from the <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> bed by loose areolar tissue. </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tonsil Bed Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formed by the <strong>superior constrictor</strong> and <strong>styloglossus muscles.</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/UCAtmAeNjFpMYvpEhvAB1738640023.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Arterial Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Tonsillar branch of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> </strong>(main supply) <strong>(Option B)</strong></li>\n<li>Ascending pharyngeal artery</li>\n<li>Ascending <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery</li>\n<li>Dorsal <span class=\"customMeta\" data-dictid=\"2d8e6d84411692777191ec7303c17d\">linguae</span> branches of the <span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\">lingual</span> artery</li>\n<li>Descending <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> branch of the maxillary artery.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/Vyh6LSVUq2X7UHZ4Wrzr1738640045.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Venous Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It drains into the <strong>paratonsillar vein</strong>, which joins the common <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> and the pharyngeal <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> plexus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lymphatic Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flows into the <strong>upper deep <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> nodes.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory Nerve Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lesser <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> branches of the <span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\">sphenopalatine</span> <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> (CN V)</strong> and the <strong>glossopharyngeal nerve.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/LRxvfbBRxuQePXdUSUE11744874953.mp3", "video": ""}, {"text": "During a tonsillectomy, injury to structures within the tonsillar bed may result in significant complications. Which of the following structures is not directly associated with the tonsillar bed but can be affected by deep dissection or improper technique?", "options": [{"label": "A", "text": "Paratonsillar vein", "correct": false}, {"label": "B", "text": "Glossopharyngeal nerve", "correct": false}, {"label": "C", "text": "Tonsillar branch of facial artery", "correct": false}, {"label": "D", "text": "Hypoglossal nerve", "correct": true}], "correct_answer": "D. Hypoglossal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/x7Tj7KMhvmd1i1LnUtpx1738640105.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:406px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures forming <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">Tonsillar</span> bed</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscles forming the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> bed</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Superior <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">Constrictor</span> Muscle</li>\n<li>Styloglossus Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures close to the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> bed (outside the superior <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle)</strong></p>\n</td>\n<td colspan=\"2\" rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Facial <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> (Tonsillar Branch): Major blood supply to the tonsils, at risk for haemorrhage during surgery.</li>\n<li>Paratonsillar Vein: <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of the tonsil, risk of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> during tonsillectomy.</li>\n<li>Submandibular Salivary Gland</li>\n<li>Posterior Belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> Muscle</li>\n<li>Medial <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">Pterygoid</span> Muscle</li>\n<li>Mandible</li>\n<li>Glossopharyngeal Nerve: Provides <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the tonsils.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/sGPlh3u1OaT61IfQgWp91744875429.mp3", "video": ""}, {"text": "A 12-year-old patient presents with a sore throat and fever. Upon examination, the physician observes that the tonsils are enlarged and other findings as in the image below. Which type of tonsillitis does this clinical presentation indicate?", "options": [{"label": "A", "text": "Acute catarrhal tonsillitis", "correct": false}, {"label": "B", "text": "Acute follicular tonsillitis", "correct": false}, {"label": "C", "text": "Chronic tonsillitis with tonsillolith", "correct": false}, {"label": "D", "text": "Acute membranous tonsillitis", "correct": true}], "correct_answer": "D. Acute membranous tonsillitis", "question_images": ["https://image.prepladder.com/notes/GBikXsHNzo13SXPstOZp1746076524.png"], "explanation_images": ["https://image.prepladder.com/content/XZA1mLq4aEPrBnZIS7ZN1738640165.png", "https://image.prepladder.com/content/otdgXcYj3bZ6jIiCnKX51738640224.png", "https://image.prepladder.com/content/ORsMEjxokkLP2v3EvQBo1738640275.png", "https://image.prepladder.com/content/JWcZalJZ7NjIxmcj55Qn1738640308.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Tonsillitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute Catarrhal <span class=\"customMeta\" data-dictid=\"5fbe79adfc1692777200030d2d13d2\">Tonsillitis</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common type and is a part of generalised pharyngitis, often viral.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Redness and mild <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the tonsils; <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat; no <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> or membrane.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"CDC/Dr. Heinz F. Eichenwald\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://www.wikilectures.eu/w/Angina#/media/File:Streptococcal_pharyngitis.jpg\" data-tags=\"\" height=\"264\" src=\"https://image.prepladder.com/content/XZA1mLq4aEPrBnZIS7ZN1738640165.png\" width=\"300\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">Follicular</span> <span class=\"customMeta\" data-dictid=\"5fbe79adfc1692777200030d2d13d2\">Tonsillitis</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection involves the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> crypts that are filled with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> material.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellowish spots at the openings of the crypts; <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat; fever.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Tonsillitis#/media/File:Pos_strep.JPG\" data-tags=\"\" height=\"551\" src=\"https://image.prepladder.com/content/otdgXcYj3bZ6jIiCnKX51738640224.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute Parenchymatous <span class=\"customMeta\" data-dictid=\"5fbe79adfc1692777200030d2d13d2\">Tonsillitis</span> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It affects the substance of the <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> and leads to uniform <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> and redness.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uniformly enlarged, red tonsils; significant swelling; no membrane.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/ORsMEjxokkLP2v3EvQBo1738640275.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute Membranous Tonsillitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progression from <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> tonsillitis; <span class=\"customMeta\" data-dictid=\"2df02c8a091692777187db6df500a1\">exudate</span> from crypts forms a <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> on the <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> surface.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The whitish or greyish <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> covering the tonsils; severe <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat; fever.</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/JWcZalJZ7NjIxmcj55Qn1738640308.png\" width=\"400\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/op7pp4ah9hPQ4Jy7D5yn1746075668.mp3", "video": ""}, {"text": "A 10-year-old boy presents with fever, sore throat, and difficulty swallowing for 3 days. On examination, there is bilateral tonsillar enlargement with purulent exudate. A rapid strep test is positive. What is the next step in management?", "options": [{"label": "A", "text": "Prescribe paracetamol and monitor for 48 hours.", "correct": false}, {"label": "B", "text": "Initiate a 7-10 day course of oral amoxicillin.", "correct": true}, {"label": "C", "text": "Administer intravenous antibiotics.", "correct": false}, {"label": "D", "text": "Perform an immediate tonsillectomy.", "correct": false}], "correct_answer": "B. Initiate a 7-10 day course of oral amoxicillin.", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> tonsillitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management Aspect</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment/Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General Supportive Care</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bed Rest and adequate fluids to aid in comfort and prevent complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptomatic Relief </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Analgesics (e.g., Aspirin, Paracetamol) to provide relief from pain and fever. <strong> (Option A)</strong><strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotic therapy</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Antibiotics are prescribed to treat bacterial infections, primarily Streptococcus.\n\t\t\t\t<ul>\n<li><strong>First-line Antibiotics:</strong> Penicillin, Ampicillin, Amoxicillin, <span class=\"customMeta\" data-dictid=\"d1e73ea72b1692777181fe0162bd92\">Amoxicillin</span> with Clavulanic acid.</li>\n<li><strong>Alternative:</strong> <span class=\"customMeta\" data-dictid=\"259b36252716927771879987e01054\">Erythromycin</span> (for <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> allergy).</li>\n</ul>\n</li>\n<li>Treatment duration is typically 7-10 days.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lY2Vu67nnxPjUwxbS0LP1746076875.mp3", "video": ""}, {"text": "A 32-year-old male presents with a recurrent sore throat, difficulty swallowing, and foul-smelling breath for the past year. He reports episodes of fever and malaise. Examination reveals enlarged tonsils that on pressing the crypt , pus oozes out and tender anterior cervical lymph nodes. What is the most likely sign seen in this patient?", "options": [{"label": "A", "text": "Griesinger’s Sign", "correct": false}, {"label": "B", "text": "Battle's Sign", "correct": false}, {"label": "C", "text": "Cottle's Sign", "correct": false}, {"label": "D", "text": "Irwin moore sign", "correct": true}], "correct_answer": "D. Irwin moore sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UNW8jdrZHn7ZafcClfUm1738640608.png", "https://image.prepladder.com/content/2rUWmXCQtckf2wk3fKvP1738640562.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chronic Tonsillitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Persistent <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> of the tonsils due to <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections or unresolved <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> tonsillitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Recurrent bacterial (e.g., <em>Streptococcus pyogenes</em>, <em>Staphylococcus aureus</em>) or <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trapped debris in <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> crypts leads to chronic inflammation, hypertrophy, and fibrosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat</li>\n<li>Halitosis</li>\n<li>Difficulty swallowing</li>\n<li>Enlarged tonsils with <span class=\"customMeta\" data-dictid=\"f98a86d8d01692777185a80a6fdbf1\">cryptic</span> pus</li>\n<li>Tender <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> lymphadenopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Irwin Moore Sign:</strong> Expression of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> from <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> crypts on pressing the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> pillar.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical based on history of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections, physical exam findings, throat culture or RADT if needed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Conservative:</strong> Antibiotics for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> infections, <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">Symptomatic</span> relief by gargling with warm/salt water and NSAIDs (for pain and inflammation).</li>\n<li><strong>Surgical:</strong> <strong>Tonsillectomy</strong>\n<ul>\n<li>It is indicated for patients with <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> infections,usually defined as\n\t\t\t\t\t<ul>\n<li>≥ 7 episodes of <span class=\"customMeta\" data-dictid=\"5fbe79adfc1692777200030d2d13d2\">tonsillitis</span> in 1 year, or</li>\n<li>≥ 5 episodes/year for 2 consecutive years, or</li>\n<li>≥ 3 episodes/year for 3 consecutive years</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<p>or those with <span class=\"customMeta\" data-dictid=\"cef39601621692777184d8f7d78f55\">chronic tonsillitis</span> <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> to medical management.</p>\n<ul>\n<li>It is also recommended for cases with complications such as <span class=\"customMeta\" data-dictid=\"61ec30ed2a16927771951418b5c9f5\">peritonsillar</span> abscess, or if <span class=\"customMeta\" data-dictid=\"cef39601621692777184d8f7d78f55\">chronic tonsillitis</span> is significantly affecting the patient’s quality of life.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peritonsillar abscess, rheumatic fever, post-streptococcal glomerulonephritis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/QX5rAgTaGp9SxpIqiE7t1746077056.mp3", "video": ""}, {"text": "A 17-year-old male presents with recurrent sore throat, recent high-grade fever, and breathing difficulties during sleep. He is scheduled for a tonsillectomy. Which among the following is a contraindication for this procedure?", "options": [{"label": "A", "text": "Obstructive sleep apnea", "correct": false}, {"label": "B", "text": "Suspicion of tonsillar carcinoma.", "correct": false}, {"label": "C", "text": "Peritonsillar abscess", "correct": false}, {"label": "D", "text": "Acute Tonsillitis", "correct": true}], "correct_answer": "D. Acute Tonsillitis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications of Tonsillectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Polio epidemic</li>\n<li>Von Willebrand's disease or <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">Bleeding</span> disorders</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute infections</li>\n<li>Hemoglobin &lt; 10 g%</li>\n<li>Uncontrolled <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> diseases, like HTN, DM, and Asthma.</li>\n<li>Age of the child is &lt;3 years</li>\n<li>During menstruation</li>\n<li>Recent <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</li>\n<li>Submucous <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> palate</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications of Tonsillectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent Tonsillitis</li>\n<li>Peritonsillar <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> <strong>(Option C)</strong></li>\n<li>Tonsillitis causing <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> seizures</li>\n<li>Tonsils <span class=\"customMeta\" data-dictid=\"653140d1dc16927771903445309f4e\">interfering</span> with speech, <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> or breathing</li>\n<li>Suspicion of <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> <strong>(Option B)</strong></li>\n<li>Obstructive sleep <span class=\"customMeta\" data-dictid=\"22b9ee5b2b16927771814b5d8d34ac\">apnea</span> <strong>(Option A)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"5fbe79adfc1692777200030d2d13d2\">tonsillitis</span> with bad taste or halitosis</li>\n<li>Diphtheria carriers<strong>,</strong>not responding to antibiotics.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/idJ2QVtRLO7NImoyZtra1746077232.mp3", "video": ""}, {"text": "A 16 year old girl, who had a tonsillectomy 6 days ago, presents with high fever, throat pain, and swelling in the neck. All the following are immediate complications of this surgery except?", "options": [{"label": "A", "text": "Primary Hemorrhage", "correct": false}, {"label": "B", "text": "Facial edema", "correct": false}, {"label": "C", "text": "Reactionary Hemorrhage", "correct": false}, {"label": "D", "text": "Parapharyngeal abscess", "correct": true}], "correct_answer": "D. Parapharyngeal abscess", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications of Tonsillectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immediate complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Delayed Complication</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Primary Hemorrhage</strong>, it happens at the time of surgery. <strong>(Option A)</strong></li>\n<li><strong>Reactionary Hemorrhage</strong> which happens within 24 hours of the surgery <strong>(Option C)</strong></li>\n<li>Injury to <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> pillars, uvula, soft palate, teeth, tongue or superior <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle</li>\n<li>Aspiration of blood</li>\n<li>Facial oedema, particularly of eyelids <strong>(Option B)</strong></li>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> (not very common)</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Secondary Hemorrhage</strong>, it happens anywhere between 5 to 10 days post-Op</li>\n<li>Infection of <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> might lead to <strong>para-pharyngeal abscess</strong> or <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media.</li>\n<li>Aspiration of blood, <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> or tissue fragments.</li>\n<li>Scarring in soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> and pillars</li>\n<li>Tonsillar remnants which may get repeatedly infected.</li>\n<li>Hypertrophy of <span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\">lingual</span> tonsil.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0HR0DXzOPodT39CBmBmp1746077790.mp3", "video": ""}, {"text": "A 15 years old female who had a tonsillectomy 16 hours ago is currently under post-op monitoring, suddenly begins to bleed from the mouth and is noted to have hypotension with tachycardia. What is the most likely cause of this bleeding?", "options": [{"label": "A", "text": "Premature membrane separation", "correct": false}, {"label": "B", "text": "Secondary infection", "correct": false}, {"label": "C", "text": "Injury to the tonsillar artery", "correct": false}, {"label": "D", "text": "Slipping of ligature", "correct": true}], "correct_answer": "D. Slipping of ligature", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type of Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reactionary Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Hemorrhage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration of occurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate complication, occur at the time of surgery.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Happens within first 24 hours post surgery (Immediate complication)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen between 5th to 10th <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> day.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"4cb859ed5d16927771884925c4eef7\">hemostasis</span> or injury to the vessels <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slipping of <span class=\"customMeta\" data-dictid=\"3e0d0648b81692777191eca3015435\">ligature</span> <strong>(Option D)</strong>, <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> or the dislodging of clot.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Infection <strong>(Option B) </strong> or <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> separation of the <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Application of pressure, <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> or <span class=\"customMeta\" data-dictid=\"418070340b16927771875ee13ba78c\">electrocoagulation</span> of the <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initially, remove the <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> and apply pressure or use a vasoconstrictor. If these measures are ineffective, proceed with <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> or <span class=\"customMeta\" data-dictid=\"418070340b16927771875ee13ba78c\">electrocoagulation</span> of the <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initially by Antibiotics, if <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> persists re-exploration is done.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/cPeekZ852d8o3Cnj2duF1746077964.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 14 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 57-year-old patient presents with otalgia and dysphagia. A CT scan reveals bilateral calcification of the stylohyoid ligaments, consistent with Eagle syndrome. During surgical repair of this condition, which pharyngeal arch-derived nerve is most likely to be affected due to its proximity?", "options": [{"label": "A", "text": "First pharyngeal arch nerve", "correct": false}, {"label": "B", "text": "Second pharyngeal arch nerve", "correct": true}, {"label": "C", "text": "Third pharyngeal arch nerve", "correct": false}, {"label": "D", "text": "Fourth pharyngeal arch nerve", "correct": false}], "correct_answer": "B. Second pharyngeal arch nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mjUtIhrAeQVsoy2bCea41738596806.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharyngeal arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscles derived</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bones derived</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cranial nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Derivatives of clefts and pouches</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mandibular <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> (Arch I)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscles of mastication,</p>\n<p>tensor veli palatini,</p>\n<p>tensor tympani,</p>\n<p>mylohyoid, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> belly of digastric.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malleus</li>\n<li>Incus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trigeminal nerve</p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>External <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> canal.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> of the first and second arches merges to further develop into the <strong>eustachian tube</strong> and the <strong>middle ear cavity.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyoid Arch</strong></p>\n<p><strong>(Arch II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expressions, stapedius, stylohyoid,</p>\n<p>posterior belly of the <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">digastric</span> muscle.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stapes</li>\n<li>Lesser horn of <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone</li>\n<li>Upper part of the body, <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone</li>\n<li>Styloid.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facial nerve</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> of the 2nd pharyngeal <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> merges with the clefts of the 3rd, 4th and 6th arches to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> sinus, which typically disappears during development.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glossopharyngeal arch</strong></p>\n<p><strong>(Arch III)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stylopharyngeus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Greater cornua of hyoid</li>\n<li>Lower part of the body of the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glossopharyngeal nerve</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thymus and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> or <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> III from the 3rd pouch.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vagal Arch</strong></p>\n<p><strong>(Arch IV &amp; V) </strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pharyngeal and laryngeal musculature</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pharyngeal and laryngeal Cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vagus nerve</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/U6rYWy0zc1wRYF5xGv8q1743749312.mp3", "video": ""}, {"text": "A 50-year-old male presents with impaired taste sensation. Examination shows diminished taste in the posterior one-third of the tongue. Which of the following nerves is responsible for this condition?", "options": [{"label": "A", "text": "Hypoglossal nerve", "correct": false}, {"label": "B", "text": "Lingual nerve", "correct": false}, {"label": "C", "text": "Chorda tympani nerve", "correct": false}, {"label": "D", "text": "Glossopharyngeal nerve", "correct": true}], "correct_answer": "D. Glossopharyngeal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UrbppJZ6BkDuODKERYUU1738596910.png", "https://image.prepladder.com/content/F8dESOHK3Hg56eSyX9lP1738596952.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Development of tongue and nerve innervation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior ⅔ of tongue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior ⅓ of tongue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior most of the tongue</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epithelial Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two <span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\">lingual</span> swellings and a <span class=\"customMeta\" data-dictid=\"37a53c4c391692777201a13335f768\">tuberculum</span> impar, made from the <span class=\"customMeta\" data-dictid=\"cce38cfecb169277719201c34df7d6\">mesoderm</span> of 1st arch, <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> ⅔ of tongue.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"d3169c09a116927771893e69784932\">hypobranchial</span> <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> is formed by the <span class=\"customMeta\" data-dictid=\"cce38cfecb169277719201c34df7d6\">mesoderm</span> of the 3rd and 4th pharyngeal arches and is further divided into <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> and <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> parts. The <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> part of this <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> gives rise to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> ⅓.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">Caudal</span> parts derived from the <span class=\"customMeta\" data-dictid=\"d3169c09a116927771893e69784932\">hypobranchial</span> <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> develop to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part of the tongue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Taste Sensation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chorda Tympani</p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glossopharyngeal nerve (supplies <span class=\"customMeta\" data-dictid=\"70e388d8381692777184989a1e1127\">circumvallate</span> papillae)</p>\n<br/>\n\t\t\t </td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Internal laryngeal nerve (Branch of Vagus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lingual nerve</p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Supply</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Except for the<strong> palatoglossus muscle,</strong> which is innervated by the <strong>vagus nerve</strong>, all other <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> and <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscles of the tongue are supplied by the <strong>hypoglossal nerve</strong>. <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscles</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All the Tongue muscles develop from <strong>Occipital Somites.</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/F8dESOHK3Hg56eSyX9lP1738596952.png\" width=\"500\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/tRQeP3Lju18rlnVx8J2b1743749590.mp3", "video": ""}, {"text": "A 36-year-old patient presents with severe sore throat, difficulty swallowing, and neck pain. On examination, there is noticeable swelling on the lateral aspect of the neck and a muffled voice. Imaging studies reveal an abscess located in the space between the superior and middle pharyngeal constrictor muscles. Which structures pass through this space?", "options": [{"label": "A", "text": "Stylopharyngeus muscle and Recurrent laryngeal nerve", "correct": false}, {"label": "B", "text": "Levator veli palatini and Glossopharyngeal nerve", "correct": false}, {"label": "C", "text": "Levator veli palatini and Recurrent laryngeal nerve", "correct": false}, {"label": "D", "text": "Stylopharyngeus muscle and Glossopharyngeal nerve", "correct": true}], "correct_answer": "D. Stylopharyngeus muscle and Glossopharyngeal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Mgf1Sl2UH9zjyNfmEULD1738597023.png", "https://image.prepladder.com/content/hSxbB16PdblqsdvwNFYm1738597043.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures passing through it</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Between the base of the skull and the superior constrictor.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Levator veli palatini <strong>(Option B and C)</strong></li>\n<li>Auditory tube/eustachian tube</li>\n<li>Tensor veli palatini</li>\n<li>Ascending <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Between the superior and the middle <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Glossopharyngeal nerve</li>\n<li>Stylopharyngeus muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Between middle and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Internal laryngeal nerve</li>\n<li>Superior laryngeal vessels</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Below the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Recurrent laryngeal nerve <strong>(Option A and C)</strong></li>\n<li>Inferior laryngeal vessels</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZG0Fb8f6R4cKICckSllC1743749923.mp3", "video": ""}, {"text": "A 55-year-old male presents with progressive hearing loss in his right ear over the past few months, along with intermittent facial pain, difficulty swallowing, palate asymmetry, and speech difficulties. Nasopharyngoscopy reveals a nasopharyngeal mass. Which structure is likely responsible for hearing loss in this patient?", "options": [{"label": "A", "text": "Cochlear nerve", "correct": false}, {"label": "B", "text": "Stylopharyngeus muscle", "correct": false}, {"label": "C", "text": "Tympanic membrane", "correct": false}, {"label": "D", "text": "Eustachian tube", "correct": true}], "correct_answer": "D. Eustachian tube", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NF5t3kEWoASup4hUwu0y1738597125.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/imnafqg4BGzLV0jgtoUw1743750124.mp3", "video": ""}, {"text": "A 50-year-old patient presents with dysphagia and a sensation of a lump in the throat. On examination, a mass is noted on the posterior pharyngeal wall. Which anatomical structure primarily forms the inner layer?", "options": [{"label": "A", "text": "Investing fascia", "correct": false}, {"label": "B", "text": "Buccopharyngeal Fascia", "correct": false}, {"label": "C", "text": "Prevertebral fascia", "correct": false}, {"label": "D", "text": "Pharyngobasilar Fascia", "correct": true}], "correct_answer": "D. Pharyngobasilar Fascia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/233H6jLRmNu06kPloeWI1738597219.png", "https://image.prepladder.com/content/tTJpar6Zk3TV3gkW2zwf1739253288.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/rMT6IvfvBmVcH7xUvF9z1744119528.mp3", "video": ""}, {"text": "A 38-year-old woman presents with six months of dysphagia, regurgitation, and a feeling of food getting stuck, often coughing while eating. A barium swallow study shows specific findings on the radiograph. Which muscle pairs define the anatomical boundaries of the observed dehiscence?", "options": [{"label": "A", "text": "Cricopharyngeus and esophageal muscle fibres", "correct": false}, {"label": "B", "text": "Thyropharyngeus and esophageal muscle fibres", "correct": false}, {"label": "C", "text": "Thyropharyngeus and cricopharyngeus", "correct": true}, {"label": "D", "text": "Inferior constrictor along with upper esophageal muscle fibres", "correct": false}], "correct_answer": "C. Thyropharyngeus and cricopharyngeus", "question_images": ["https://image.prepladder.com/content/fryiuEuPVNs3aRk3E6vn1738605670.png"], "explanation_images": ["https://image.prepladder.com/content/hmvr9WCxJW0MZeAv6yTs1738605877.png", "https://image.prepladder.com/content/1JUWif1eMhZpwkT2Dlg41738605776.png", "https://image.prepladder.com/content/g19381CRAZBxV5V4LNyf1738605822.png", "https://image.prepladder.com/content/OC0BgKcus49Mcbdov2qF1738606142.png", "https://image.prepladder.com/content/RD00VnaqGEEfBUskCVb81738605973.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>An acquired, false, and <span class=\"customMeta\" data-dictid=\"cf49aa21c616927771961992dfef4e\">pulsion</span> <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> formed by the <span class=\"customMeta\" data-dictid=\"08b787c5a41692777196c0e16b3805\">protrusion</span> of <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and <span class=\"customMeta\" data-dictid=\"8549d0b4091692777199fc12af07aa\">submucosa</span> through Killian's dehiscence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia</li>\n<li>Regurgitation</li>\n<li>Food getting stuck (leading to coughing while eating)</li>\n<li>Aspiration</li>\n<li>Halitosis (bad breath)</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/hmvr9WCxJW0MZeAv6yTs1738605877.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Barium swallow reveals an <span class=\"customMeta\" data-dictid=\"9573d4999216927771943e3f309d90\">outpouching</span> of the pharyngeal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> above the upper oesophagal sphincter, often with slow <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of the diverticulum.</p>\n\t\t\t \n\n\t\t\t<p style=\"text-align:center\"><img alt=\"\" data-author=\"Hellerhoff\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Zenker_Divertikel_Stadien.jpg\" data-tags=\"\" height=\"164\" src=\"https://image.prepladder.com/content/1JUWif1eMhZpwkT2Dlg41738605776.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Diverticulectomy and <span class=\"customMeta\" data-dictid=\"07bb7766221692777185a58cad9233\">cricopharyngeal</span> myotomy: </strong>Surgical removal of the <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> and <span class=\"customMeta\" data-dictid=\"93f5e249981692777193d45e332ceb\">myotomy</span> of the <span class=\"customMeta\" data-dictid=\"07bb7766221692777185a58cad9233\">cricopharyngeal</span> muscle.</li>\n<li><strong>Diverticular suspension:</strong> Dissection and <span class=\"customMeta\" data-dictid=\"94fdb58dbf16927771904508108f50\">inversion</span> of the <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> with its <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> pointing cranially.</li>\n<li><strong>Myotomy through stapler transection: </strong>Transoral <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of a <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> stapler to divide the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> between the <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> and the true oesophagal lumen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dohlman Procedure:</strong><strong> </strong>Endoscopic technique involving division of the <span class=\"customMeta\" data-dictid=\"d12c5027f91692777186803150d054\">diverticulum</span> wall and <span class=\"customMeta\" data-dictid=\"07bb7766221692777185a58cad9233\">cricopharyngeal</span> myotomy.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:695px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Killian’s dehiscence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A weak area situated between the two components of the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle: the thyropharyngeus and the cricopharyngeus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Laimer’s dehiscence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A midline structure situated below Killian’s <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> formed by the <span class=\"customMeta\" data-dictid=\"dd058047bf169277718506087fd675\">cricopharyngeus muscle</span> and the upper <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> muscle fibres of the esophagus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Killian Jamieson's area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"572cb31e4e1692777185daa75a497b\">dehiscence</span> situated laterally and inferiorly to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle, formed by the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle and the upper fibres of the oesophagus.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/TCivNQJEjRY0kzTlNgeu1744742285.mp3", "video": ""}, {"text": "A 35-year-old female presenting with persistent right ear fullness, hearing loss, and pressure particularly during flights is suspected of having Eustachian tube blockage. During rhinoscopy, a structure labelled as X in the image below is noted. Identify this structure.", "options": [{"label": "A", "text": "Pyriform fossa", "correct": false}, {"label": "B", "text": "Torus tubarius", "correct": false}, {"label": "C", "text": "Fossa of Rosenmuller", "correct": true}, {"label": "D", "text": "Post cricoid region", "correct": false}], "correct_answer": "C. Fossa of Rosenmuller", "question_images": ["https://image.prepladder.com/notes/Z5Ozvx6hRfvNTMarrWkX1744777999.png"], "explanation_images": ["https://image.prepladder.com/content/AxXmLyNx6Sz1WzKpxRQv1738606327.png", "https://image.prepladder.com/content/TjJdJ49dnGNvtnZCpoua1738606476.png", "https://image.prepladder.com/content/0tXDkPSN2r7x13oCL9bK1738606532.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Boundaries </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Relations </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Roof </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formed by <span class=\"customMeta\" data-dictid=\"9f6ec084eb1692777182c3e350ef8c\">basisphenoid</span> and basiocciput.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior wall</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>C1 <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> covered by <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> muscles and fascia</li>\n<li>The roof and the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> wall merge gradually with one another.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Floor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It is formed by the soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> anteriorly but is deficient posteriorly.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> connects to the <span class=\"customMeta\" data-dictid=\"4356afe522169277719436b593e4b1\">oropharynx</span> (nasopharyngeal isthmus).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior wall</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Formed by <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> apertures or choanae.</li>\n<li>Posterior ends of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> turbinates and meatuses are seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lateral wall </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Eustachian tube </strong></li>\n<li><strong>Torus tubarius: </strong>A cushion-like <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> that borders the Eustachian tube from above and behind. <strong>(Option B)</strong></li>\n<li><strong>Fossa of Rosenmuller: </strong>A <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> above and behind the <span class=\"customMeta\" data-dictid=\"7dd101b7301692777200313ccb5ecc\">torus</span> tubarius <strong>(the most common site for <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> origin)</strong>.</li>\n<li><strong>Salpingopharyngeal fold: </strong>A ridge extends from the lower end of the <span class=\"customMeta\" data-dictid=\"7dd101b7301692777200313ccb5ecc\">torus</span> tubarius to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> pharyngeal wall.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/w1EKUl2uyCkrTypeTYM01744819026.mp3", "video": ""}, {"text": "A 7-year-old girl presents with hypernasal speech and nasal regurgitation of fluids while drinking. She is diagnosed with palatal palsy. Which structure is responsible for separating the nasopharynx from the oropharynx during swallowing, preventing regurgitation?", "options": [{"label": "A", "text": "Passavant’s ridge", "correct": true}, {"label": "B", "text": "Sinus of Morgagni", "correct": false}, {"label": "C", "text": "Rathke’s pouch", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "A. Passavant’s ridge", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GQifmkhnuTyf2iS4wSRF1738606710.png", "https://image.prepladder.com/content/AVtddp4F0CXbWcffoM0L1738606868.png", "https://image.prepladder.com/content/TFCaTyCW29WSUZc6BEIW1738606982.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Palatal paralysis</li>\n<li>Cleft palate</li>\n<li>Submucosal cleft</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Though it can occur without any obvious <span class=\"customMeta\" data-dictid=\"733f60c2581692777194690224e6eb\">palatal</span> abnormalities, it is more common in children with</p>\n<ul>\n<li>Repaired <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> palate,</li>\n<li>Submucous cleft</li>\n<li>Post adenoidectomy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The failure of the <span class=\"customMeta\" data-dictid=\"528886a2ed16927772014326a7c2b6\">velum</span> (soft palate) to properly close against the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall results in the <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> of food into the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> and a hypernasal voice (rhinolalia aperta).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Regurgitation of food and water into the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity</li>\n<li>Hypernasal voice</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Speech therapy</li>\n<li>Palatal or pharyngeal surgery</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/0HEier2x3BgIV6sjT1Rf1744742887.mp3", "video": ""}, {"text": "A teenager presented with a sore throat, difficulty swallowing, and a fever for the past three days. During the oral examination, the ENT surgeon asked the intern about the anatomy of the pharyngeal region located behind the oral cavity. Which of the following is not true about the anatomy of that region ?", "options": [{"label": "A", "text": "Anterior pillar is formed by the palatoglossus muscle", "correct": false}, {"label": "B", "text": "The lateral wall comprises the anterior and posterior pillars", "correct": false}, {"label": "C", "text": "Anterior pillar with uvula form the oropharyngeal isthmus", "correct": false}, {"label": "D", "text": "The posterior wall lies opposite the atlas vertebra.", "correct": true}], "correct_answer": "D. The posterior wall lies opposite the atlas vertebra.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LHillshMImBXxhO9z8uU1738607144.png", "https://image.prepladder.com/content/iJzpmfRS3ax79yNSOIuf1738607173.png", "https://image.prepladder.com/content/0r6Kznt22KRVmFbF2Yuf1738607211.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Roof </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The plane of the hard palate.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Floor </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The plane of the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior wall</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lies opposite the 2nd and upper part of the 3rd <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> <strong>(Option D) </strong>and is<strong> </strong><strong>r</strong>elated to <span class=\"customMeta\" data-dictid=\"c2e956a8441692777197ea505fc27d\">retropharyngeal</span> space.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior wall </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It is deficient above (oropharynx communicates with the oral cavity)</p>\n<p>Inferiorly it presents:</p>\n<ul>\n<li>Base of tongue (posterior 1/3rd)</li>\n<li>Lingual tonsil</li>\n<li><strong>Valleculae</strong>: Cup-shaped depressions, between the tongue and epiglottis, are bordered by the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> <span class=\"customMeta\" data-dictid=\"7b5f8e38321692777188a159fe5568\">glossoepiglottic</span> fold and <span class=\"customMeta\" data-dictid=\"9f1556bb83169277719527ac5806b3\">pharyngoepiglottic</span> fold. They often contain <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> cysts.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/iJzpmfRS3ax79yNSOIuf1738607173.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral wall</strong><br/>\n<strong>(Option A, B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Palatine (faucial) tonsil</li>\n<li>Anterior pillar/palatoglossal <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> (formed by the palatoglossus muscle) <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> pillar/palatopharyngeal <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> (formed by the palatopharyngeus muscle).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/8vCEx4pFmAhMquMV3QDq1744743684.mp3", "video": ""}, {"text": "A 56-year-old woman with a history of Plummer-Vinson syndrome presents with dysphagia, hoarseness, weight loss, and right-sided cervical lymphadenopathy. What is the most likely cause of her symptoms, and which area is most commonly affected?", "options": [{"label": "A", "text": "Carcinoma Esophagus, Pyriform fossa", "correct": false}, {"label": "B", "text": "Carcinoma Pharynx, Posterior pharyngeal wall", "correct": false}, {"label": "C", "text": "Carcinoma Esophagus, Post cricoid region", "correct": true}, {"label": "D", "text": "Carcinoma pharynx, Valleculae", "correct": false}], "correct_answer": "C. Carcinoma Esophagus, Post cricoid region", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zzLDV5hOOB4umsfEqoJu1738607296.png", "https://image.prepladder.com/content/xO9Wagegh49VgMOplrD61738607365.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The plane passes from the body of the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The lower border of <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> where it continues with the esophagus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lies opposite to 3rd, 4th, 5th, 6th <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> vertebrae.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Communicates with the larynx.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:644px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pyriform <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> (sinus) or </strong> <strong>Smuggler’s pouch</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It lies on either side of the <span class=\"customMeta\" data-dictid=\"80452d1746169277719165b097dc7a\">larynx</span> and extends from <span class=\"customMeta\" data-dictid=\"9f1556bb83169277719527ac5806b3\">pharyngoepiglottic</span> fold to the upper end of the oesophagus.</li>\n<li>It is bounded as,\n\t\t\t\t<ul>\n<li>Laterally: the <span class=\"customMeta\" data-dictid=\"c28dda8ac016927772002610f0ea78\">thyrohyoid</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cartilage.</li>\n<li>Medially: <span class=\"customMeta\" data-dictid=\"bcb66a68f6169277718280ac9256a5\">aryepiglottic</span> fold and <span class=\"customMeta\" data-dictid=\"0b858004a11692777196bac353c12b\">posterolateral</span> surfaces of <span class=\"customMeta\" data-dictid=\"c73bdca3d81692777182aebed4714a\">arytenoid</span> and <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> cartilages.</li>\n</ul>\n</li>\n<li>It creates the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> channel for food and can trap foreign bodies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> region</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Part of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> wall of <span class=\"customMeta\" data-dictid=\"f184b5bbbb1692777191d7cfd3ef40\">laryngopharynx</span> between the upper and lower borders of <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">cricoid</span> lamina.</li>\n<li>It is a common site for <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in females suffering from Plummer-Vinson syndrome.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior pharyngeal wall </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It extends from the level of <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone to the level of <span class=\"customMeta\" data-dictid=\"f54dba40a116927771859fc53d2f9f\">cricoarytenoid</span> joint.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/DEiC9nnBEXyDMjxMYwmZ1744819499.mp3", "video": ""}, {"text": "Identify the structure indicated as ‘X’ in the image.", "options": [{"label": "A", "text": "Palatine tonsil", "correct": false}, {"label": "B", "text": "Gerlach’s tonsil", "correct": false}, {"label": "C", "text": "Lingual tonsil", "correct": false}, {"label": "D", "text": "Luschka’s tonsil", "correct": true}], "correct_answer": "D. Luschka’s tonsil", "question_images": ["https://image.prepladder.com/content/JHPwExcPMFn8WmPwjEEW1738607456.png"], "explanation_images": ["https://image.prepladder.com/content/Wivh5fMqD6hQJxg67wIJ1738607655.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/YUw1eZ2qUk0UOr3ITHml1744820494.mp3", "video": ""}, {"text": "A 28-year-old female arrives at the emergency department with a severe sore throat, difficulty swallowing, fever, a muffled voice, and drooling. Examination reveals tonsil being pushed medially and uvula deviated to opposite side . Which of the following options defines the boundaries of the infected space?", "options": [{"label": "A", "text": "Palatine tonsil and styloglossus", "correct": false}, {"label": "B", "text": "Lingual tonsil and superior constrictor", "correct": false}, {"label": "C", "text": "Palatine tonsil and superior constrictor", "correct": true}, {"label": "D", "text": "Lingual tonsil and styloglossus", "correct": false}], "correct_answer": "C. Palatine tonsil and superior constrictor", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qnErKZWWfFsYol9xnSt11738607758.png", "https://image.prepladder.com/content/8Gxmp3j1ngHCRzD0O7ak1738607785.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ElGuduESvy44KJyMPffS1744821978.mp3", "video": ""}, {"text": "A 7-year-old girl presents with severe throat pain, high fever, difficulty swallowing, excessive drooling, and trouble breathing. Examination reveals swelling in the posterior throat. The ENT specialist mentions that the infected space includes the nodes of Rouviere. Which space is affected?", "options": [{"label": "A", "text": "Parapharyngeal space", "correct": false}, {"label": "B", "text": "Retropharyngeal space", "correct": true}, {"label": "C", "text": "Prevertebral space", "correct": false}, {"label": "D", "text": "Sublingual space", "correct": false}], "correct_answer": "B. Retropharyngeal space", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Z2ZAlhhrJphQYlW9Ygzs1738608062.png", "https://image.prepladder.com/content/WgItRdFiieWSpGcI8Gaq1738608110.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/s4qN9btq9rtkyn7BmE0s1744822405.mp3", "video": ""}, {"text": "A 5-year-old child presents with persistent nasal congestion, unilateral nasal discharge, and occasional nosebleeds, along with frequent ear infections and a slightly nasal voice. Posterior rhinoscopy is planned. Which of the following structures are normally visible during this procedure?", "options": [{"label": "A", "text": "Adenoids", "correct": true}, {"label": "B", "text": "Tubal tonsils", "correct": false}, {"label": "C", "text": "Pyriform fossa", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "A. Adenoids", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oyiIhMRRpJcYszj3KFtZ1738608212.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior Rhinoscopy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> procedure used to examine the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part of the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, including the nasopharynx.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structures </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Following structures are normally visible in <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> rhinoscopy:</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/oyiIhMRRpJcYszj3KFtZ1738608212.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Choanal polyp</li>\n<li>Choanal atresia</li>\n<li>Hypertrophy of <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> ends of <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> turbinates</li>\n<li>Discharge in the middle <span class=\"customMeta\" data-dictid=\"6da3f0528c1692777192e9b608d735\">meatus</span> and above it.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dhn7BrxgfXMxrYzq4krR1744822830.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 24 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 5 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following is a risk factor for nasopharyngeal carcinoma? Epstein-Barr (EB) virus Dry salted fish Chinese population Cigarette smoking Opium smoking Inhalation of smoke from Incense", "options": [{"label": "A", "text": "1, 2, 3 and 4", "correct": false}, {"label": "B", "text": "1, 4 and 6", "correct": false}, {"label": "C", "text": "All except 2 and 5", "correct": false}, {"label": "D", "text": "All the above", "correct": true}], "correct_answer": "D. All the above", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genetic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Higher <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> in the Chinese population </strong><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Viral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epstein-Barr (EB) virus </strong><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Environmental</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Air pollution</li>\n<li>Smoking (tobacco, opium)</li>\n<li><strong>Nitrosamines from dry salted fish</strong></li>\n<li>Inhalation of smoke from Incense</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nasal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Obstruction</li>\n<li>Discharge</li>\n<li>Denasal speech (rhinolalia clausa)</li>\n<li>Epistaxis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Otologic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conductive hearing loss</li>\n<li><strong>Serous or <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media (Unilateral <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media in adults is an important indicator)</strong></li>\n<li>Tinnitus</li>\n<li>Dizziness due to <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ophthalmoneurologic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Squint</li>\n<li>Diplopia (CN VI involvement)</li>\n<li>Ophthalmoplegia (CN III, IV, VI)</li>\n<li>Facial pain</li>\n<li>Reduced corneal <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (CN V involvement)</li>\n<li>Exophthalmos</li>\n<li>Blindness (CN II)</li>\n<li>Jugular <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> syndrome with CN IX, X, and XI involvement</li>\n<li>Horner syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervical Nodal Metastases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lump of nodes between the angle of the jaw and mastoid, or along the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> triangle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant Metastases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common sites-bone, lung, and liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Common symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cervical lymphadenopathy</li>\n<li>Hearing loss</li>\n<li>Nasal obstruction</li>\n<li>Epistaxis</li>\n<li>Cranial nerve palsies (CN VI most common)</li>\n<li>Headache</li>\n<li>Earache</li>\n<li>Neck pain</li>\n<li>Weight loss</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/W1QnvmCj43FMz405cXKz1745001629.mp3", "video": ""}, {"text": "A 58-year-old man presents with persistent nasal obstruction and bloody nasal discharge over the past 3 months. On examination, he has unilateral conductive hearing loss and a swelling in his neck. Imaging studies reveal a nasopharyngeal mass with cervical lymphadenopathy. Which of these symptoms is a part of the Trotter's triad?", "options": [{"label": "A", "text": "Nasal obstruction", "correct": false}, {"label": "B", "text": "Epistaxis", "correct": false}, {"label": "C", "text": "Conductive hearing loss", "correct": true}, {"label": "D", "text": "Cervical lymphadenopathy", "correct": false}], "correct_answer": "C. Conductive hearing loss", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:657px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Endoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Biopsy is taken</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Imaging</strong></p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>CT Scan/MRI of Nasopharynx and Neck - High-resolution, contrast-enhanced CT is the preferred method</li>\n<li>MRI of Nasopharynx and Neck - better for assessing soft-tissue extension and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>Positron Emission Tomography (PET) - for detecting <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> throughout the body</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Screening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epstein-Barr <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> markers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Audiogram</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosing of <span class=\"customMeta\" data-dictid=\"3963a2e0fa169277719874304f5705\">serous</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media</li>\n<li>Monitors for side effects of radiation and chemotherapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4WRPWGIOii1aDBS3WriM1745001895.mp3", "video": ""}, {"text": "A 55-year-old male presents with nasopharyngeal carcinoma. On examination, he has a large nasopharyngeal mass with invasion into the surrounding bony structures and involvement of the intracranial space. Imaging studies reveal multiple lymph nodes in the neck, some of which are greater than 6 cm in size. There is no evidence of distant metastasis . What is the TNM staging of this cancer?", "options": [{"label": "A", "text": "T4N3aM0", "correct": true}, {"label": "B", "text": "T2N2M1", "correct": false}, {"label": "C", "text": "T3N1M1", "correct": false}, {"label": "D", "text": "T1N1M1", "correct": false}], "correct_answer": "A. T4N3aM0", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:732px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Category</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Description</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary Tumour (T)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour confined to the nasopharynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour extends to soft tissues of the <span class=\"customMeta\" data-dictid=\"4356afe522169277719436b593e4b1\">oropharynx</span> and/or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumour invades bony structures and/or <span class=\"customMeta\" data-dictid=\"e23ca9914316927771948eba43a1e9\">paranasal</span> sinuses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tumour with <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension and/or involvement of <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves, <span class=\"customMeta\" data-dictid=\"5b1134ed2e169277719040dbf157ba\">infratemporal</span> fossa, hypopharynx, orbit, or masticator space</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Nodes (N)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nx</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unilateral <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node(s), ≤6 cm in greatest dimension, above the <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, ≤6 cm in greatest dimension, above the <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>N3a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metastasis greater than 6 cm in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node(s) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N3b</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metastasis in <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node(s) in the <span class=\"customMeta\" data-dictid=\"53765334f31692777199cf434360de\">supraclavicular</span> fossa</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> (M)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MX</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>No distant metastasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>M1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/M2ClBhtlu88OiM9vJmJA1745002284.mp3", "video": ""}, {"text": "Which of the following is the common symptom of juvenile nasopharyngeal angiofibroma?", "options": [{"label": "A", "text": "Diplopia", "correct": false}, {"label": "B", "text": "Recurrent Epistaxis", "correct": true}, {"label": "C", "text": "Conductive hearing loss", "correct": false}, {"label": "D", "text": "Nasal Discharge", "correct": false}], "correct_answer": "B. Recurrent Epistaxis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/v5GlUswMfrLNeVOXHtt11738641421.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>JNA - Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasal and <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">Nasopharyngeal</span> Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Epistaxis: <strong>Recurrent</strong>, profuse nosebleeds due to fragile, thin-walled vessels. <strong>(Option B)</strong></li>\n<li>Nasal Obstruction: Progressive <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> causing <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> voice.</li>\n<li>Nasal Discharge: Often from secondary <span class=\"customMeta\" data-dictid=\"3207c2541a1692777198f4af88308b\">sinusitis</span> or obstruction.<strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Otologic Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conductive Hearing Loss: <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> leading to fluid in the middle ear. <strong>(Option C ruled out)</strong></li>\n<li>Otitis Media with Effusion: Fluid build-up, possible ear pain.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ophthalmo-neurological Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Proptosis: <span class=\"customMeta\" data-dictid=\"53c6bebcbb169277718777b3fe0e5c\">Eyeball</span> <span class=\"customMeta\" data-dictid=\"08b787c5a41692777196c0e16b3805\">protrusion</span> from <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> invasion.</li>\n<li>Diplopia: <span class=\"customMeta\" data-dictid=\"059a36b6c21692777186f53c4ed763\">Double vision</span> due to <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> (CN III, IV, VI). <strong>(Option A ruled out)</strong></li>\n<li>Cranial Nerve Palsies: Various deficits like vision changes (CN II), <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> pain (CN V), or <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> difficulty (CN IX, X).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Facial Deformity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Broadening of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Bridge: Widening from tumor pressure.</li>\n<li>Cheek Swelling: <span class=\"customMeta\" data-dictid=\"0bead1317716927771827dc3e80706\">Asymmetry</span> due to tumor extension.</li>\n<li>Frog-Face Deformity: <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">Bilateral</span> <span class=\"customMeta\" data-dictid=\"4edef7912e1692777196cb0f66e35d\">proptosis</span> with bulging eyes and flattened profile.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Rajat kumar Dash , Smruti Swain , Subrat Kumar Behera , Subhalaxmi Rautray\" data-hash=\"\" data-license=\"CC BY NC \" data-source=\"https://aimdrjournal.com/wp-content/uploads/2021/10/EN1_OA_Smruti-edit.pdf\" data-tags=\"\" height=\"500\" src=\"https://image.prepladder.com/content/v5GlUswMfrLNeVOXHtt11738641421.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Age and Sex: Predominantly affects adolescent males (10-20 years)</strong>. Rare in females or older individuals.</li>\n<li>Endoscopic Appearance: Smooth or <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> reddish-purple mass <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages.</li>\n<li>Consistency: Firm but should not be palpated due to <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/2zYDy8kKDh77GmGDYwqk1745002906.mp3", "video": ""}, {"text": "A 17-year-old male presents with recurrent epistaxis, nasal obstruction, and a reddish-purple mass visible in the nasal cavity. He also reports occasional facial pain. CECT scan finding is shown below. Which investigation is most useful in evaluating the vascularity of this tumor and planning for preoperative embolization?", "options": [{"label": "A", "text": "Magnetic resonance imaging", "correct": false}, {"label": "B", "text": "Ultrasound Doppler", "correct": false}, {"label": "C", "text": "Nasopharyngoscopy", "correct": false}, {"label": "D", "text": "Digital Subtraction Angiography", "correct": true}], "correct_answer": "D. Digital Subtraction Angiography", "question_images": ["https://image.prepladder.com/notes/ngB0zfZzWgsUAMWmyaB71745057419.png"], "explanation_images": ["https://image.prepladder.com/notes/CtzQekGu9XxqCidfOfk01745057571.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examination of <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">Juvenile</span> <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anterior Rhinoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reveals a reddish-purple mass obstructing the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> passages, often with blood-stained discharge.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Posterior Rhinoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visualizes a smooth or <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> mass in the <span class=\"customMeta\" data-dictid=\"c3f198d2a31692777193e32f2c868c\">nasopharynx</span> using a small mirror.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Oral Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses for tumor extension into the oral cavity, possibly pushing the soft <span class=\"customMeta\" data-dictid=\"a0f278b4b416927771943c92485603\">palate</span> downwards.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neck Palpation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects any enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, especially in the upper <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> region.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neurological Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve involvement, <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> on eye movements, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> sensation, and hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Digital palpation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Caution,</strong><strong> avoid </strong>digital <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> of the <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> mass to prevent severe bleeding.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations of <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">Juvenile</span> <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contrast-Enhanced CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice</strong>; shows tumor size, location, and bony involvement.</li>\n<li>Pathognomonic sign: Holman-Miller sign (bowing of maxillary wall).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates soft tissue and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension, differentiates between <span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\">extradural</span> and <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> spread. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Digital <span class=\"customMeta\" data-dictid=\"408be3f8d81692777199619278702d\">Subtraction</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> (DSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visualizes tumor vascularity, identifies <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels and aids in <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> to reduce <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> blood loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nasopharyngoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides a direct view of the tumor, but <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is generally avoided due to high <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk. <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> caused by <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube obstruction; establishes <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> and monitors post-treatment hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biopsy is<strong> contraindicated</strong> due to risk of profuse bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PJTASwo5nANHAlUhZs1A1745003152.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 15 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 9 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 7-year-old child presents to the ER with rapidly progressing swelling under the jaw and difficulty breathing. On examination, there is bilateral submandibular swelling with elevation of the tongue, but no trismus or fluctuation. He reports recent dental pain in his lower molars. Which anatomical connection is primarily responsible for the rapid bilateral spread of this infection?", "options": [{"label": "A", "text": "Between the submental and parapharyngeal spaces", "correct": false}, {"label": "B", "text": "Between the sublingual and retropharyngeal spaces", "correct": false}, {"label": "C", "text": "Between the submandibular and submental spaces", "correct": true}, {"label": "D", "text": "Between the submental and buccal spaces", "correct": false}], "correct_answer": "C. Between the submandibular and submental spaces", "question_images": ["https://image.prepladder.com/content/H3ntZJx3IDyW0fHWQyl51738641729.png"], "explanation_images": ["https://image.prepladder.com/content/QpQ5rNFfsVrjje0SYG241738641775.png", "https://image.prepladder.com/content/G5tiXb0Lx3Gl5NwNYGMs1738641924.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ludwig’ <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> - Anatomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary Spaces</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It involves three spaces around the mandible: the sublingual, submandibular, and <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> spaces.</p>\n<ul>\n<li><strong>Sublingual space</strong>: Infections here typically arise from the premolars and first molar.</li>\n<li><strong>Submandibular space</strong>: It contains the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, and connects to both the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> and <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> spaces.<strong> (Option C)</strong></li>\n<li><strong>Submental space</strong>: Infections in the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> space can easily spread to the <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> and <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> spaces.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Secondary Spaces</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The secondary spaces, known collectively as the masticator space, surround the muscles involved in <span class=\"customMeta\" data-dictid=\"7beec9567a1692777191ec123e0989\">mastication</span> (masseter, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> pterygoid, and temporalis).</li>\n<li>These spaces can become involved due to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> spread of infection from the primary spaces or from a <span class=\"customMeta\" data-dictid=\"8881e191391692777200888db48f0f\">third molar</span> infection.</li>\n<li>The primary clinical feature of masticator space infection is <strong>significant trismus.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/g0UCirEnHpQiVe0tMJBU1744910886.mp3", "video": ""}, {"text": "A 40-year-old female presents with bilateral submandibular swelling and difficulty swallowing. On examination the swelling is \"woody-hard,\" and the patient exhibits trismus. A CECT scan confirms the presence of diffuse cellulitis without a well-formed abscess. Which of the following is the most critical initial step in managing this condition?", "options": [{"label": "A", "text": "Administer intravenous corticosteroids to reduce inflammation", "correct": false}, {"label": "B", "text": "Perform an intraoral incision and drainage to relieve pressure", "correct": false}, {"label": "C", "text": "Initiate systemic broad-spectrum antibiotics immediately", "correct": true}, {"label": "D", "text": "Conduct a repeat contrast-enhanced CT scan to monitor progression", "correct": false}], "correct_answer": "C. Initiate systemic broad-spectrum antibiotics immediately", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ludwig’ angina</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>General Symptoms: Severe difficulty <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> (<strong>odynophagia</strong>) and varying degrees of <strong>trismus </strong>(difficulty opening the mouth).</li>\n<li><strong>Symptoms depend on infection location and extent:</strong>\n<ul>\n<li>Sublingual Space: <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">Swelling</span> in the floor of the mouth, pushing the tongue upward and backwards.</li>\n<li>Submandibular Region: <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">Swelling</span> and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> in the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> area, often described as \"<strong>woody</strong>-<strong>hard</strong>.\"</li>\n<li>Progression: The tongue can displace upward and backward, potentially obstructing the airway, with possible laryngeal edema.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical Evaluation: Assess symptoms, including swelling, tenderness, trismus, and <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> compromise.</li>\n<li>Imaging Studies:\n\t\t\t\t<ul>\n<li><strong>Ultrasound:</strong> Identifies <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> presence and location.</li>\n<li><strong>Contrast-enhanced CT Scan</strong>: Differentiates between <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> and <span class=\"customMeta\" data-dictid=\"0985f5f6041692777184d2e82e558c\">cellulitis</span> (Phlegmon), revealing infection extent.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Systemic Antibiotics</strong>: <strong>Broad-spectrum antibiotics</strong> to target mixed <span class=\"customMeta\" data-dictid=\"789c9dd31a16927771801dd2426384\">aerobic</span> and <span class=\"customMeta\" data-dictid=\"4880fc99551692777181e25a64560f\">anaerobic</span> bacteria.</li>\n<li><strong>Incision and Drainage:</strong> Necessary if an <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> is present. <strong>(Option B ruled out)</strong>\n<ul>\n<li><strong>Intraoral Approach</strong>: For infections confined to the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> space.</li>\n<li><strong>External Approach</strong>: For infections in the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> and <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> spaces, involving a <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> along the mandible.</li>\n</ul>\n</li>\n<li><strong>Airway Management: </strong>Maintaining a patent <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> is crucial; <span class=\"customMeta\" data-dictid=\"955bd148331692777200316f3d9855\">tracheostomy</span> may be needed in severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spread of Infection: May extend to the <span class=\"customMeta\" data-dictid=\"161110ecdc16927771941c70d7bcad\">parapharyngeal</span> and <span class=\"customMeta\" data-dictid=\"c2e956a8441692777197ea505fc27d\">retropharyngeal</span> spaces and potentially to the mediastinum, causing mediastinitis.</li>\n<li>Airway Obstruction</li>\n<li>Septicaemia</li>\n<li>Aspiration Pneumonia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/j3aeVCfN3czTnES5AoTf1745605663.mp3", "video": ""}, {"text": "In the development of a pharyngeal pouch, which anatomical area is primarily affected?", "options": [{"label": "A", "text": "Killian’s dehiscence", "correct": true}, {"label": "B", "text": "Vallecula", "correct": false}, {"label": "C", "text": "Pyriform sinus", "correct": false}, {"label": "D", "text": "Uvula", "correct": false}], "correct_answer": "A. Killian’s dehiscence", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NJb5frdGGYIV1YxSxCLT1738642216.png", "https://image.prepladder.com/content/mUVTnRCydsCIP6YKB2gZ1738642368.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/PIZGIuzPQHpdMgHqEpqf1744911217.mp3", "video": ""}, {"text": "A 65-year-old man presents with progressive dysphagia, regurgitation of undigested food, chronic bad breath, and a gurgling sound in his neck during swallowing. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Achalasia", "correct": false}, {"label": "B", "text": "Gastroesophageal reflux disease (GERD)", "correct": false}, {"label": "C", "text": "Zenker's diverticulum", "correct": true}, {"label": "D", "text": "Plummer-Vinson syndrome", "correct": false}], "correct_answer": "C. Zenker's diverticulum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UCHIEOlBsI4u875MJB7Y1738642579.png", "https://image.prepladder.com/content/Dn9zSnxyRvzQwuIPVUpj1738643050.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/chMnkYsYCkes3ADg7Y4F1744990948.mp3", "video": ""}, {"text": "Which of the following statements about the parapharyngeal space is/are correct? 1) The parapharyngeal space extends from the base of the skull to the tracheal bifurcation. 2) The retropharyngeal space communicates with the parapharyngeal space. 3) The anterior compartment of the parapharyngeal space is related to the medial pterygoid muscle. 4) The posterior compartment of the parapharyngeal space contains the carotid artery, jugular vein, and cranial nerves IX, X, XI, XII.", "options": [{"label": "A", "text": "only 1", "correct": false}, {"label": "B", "text": "1, 3, 4", "correct": false}, {"label": "C", "text": "2, 3, 4", "correct": true}, {"label": "D", "text": "only 2", "correct": false}], "correct_answer": "C. 2, 3, 4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zYSpCnJdWbkTNtDtdCDX1738643254.png", "https://image.prepladder.com/content/RsJxk60eguPX4sNdu5KC1738643290.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Retro- pharyngeal Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Behind the pharynx</li>\n<li><strong>Extent:</strong> from the skull base to <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> bifurcation. <strong>(Statement 1)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infection may spread to the mediastinum.</li>\n<li>Divided into spaces of Gillette by <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> raphe.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pre- vertebral Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Between vertebral bodies (posterior) and <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> (anterior)</li>\n<li><strong>Extent:</strong> from the skull base to coccyx</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Infections often from vertebral caries.</li>\n<li>Abscess causes a midline bulge.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/el4LVskowqPtjaOj7JWN1744912836.mp3", "video": ""}, {"text": "Adult male with complaints of fever, throat pain on left side, painful swallowing with change in voice since 2 days. Oral examination revealed the following. No visible neck swelling is seen. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Parapharyngeal abscess", "correct": false}, {"label": "B", "text": "Ludwig’s angina", "correct": false}, {"label": "C", "text": "Quinsy", "correct": true}, {"label": "D", "text": "Retropharyngeal abscess", "correct": false}], "correct_answer": "C. Quinsy", "question_images": ["https://image.prepladder.com/content/zqOQP2x2DAkGP71FjVeX1738643382.png"], "explanation_images": ["https://image.prepladder.com/content/wQR6mqPBnCb5wQUqUfY41738643422.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> in the <span class=\"customMeta\" data-dictid=\"61ec30ed2a16927771951418b5c9f5\">peritonsillar</span> space (between <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> and superior <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Follows <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"5fbe79adfc1692777200030d2d13d2\">tonsillitis</span> or can arise <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> novo.</li>\n<li>Infection begins in the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> crypt</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Streptococcus pyogenes, S. aureus, anaerobes or mixed infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever with chills &amp; rigors</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> throat pain</li>\n<li>Odynophagia (difficulty swallowing)</li>\n<li>Muffled \"<strong>hot potato voice</strong>\", foul breath</li>\n<li>Ipsilateral <span class=\"customMeta\" data-dictid=\"a5203a30961692777186fa0ceba5a7\">earache</span> (referred via CN IX)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swollen, <span class=\"customMeta\" data-dictid=\"8edfbdf9211692777184ea95263168\">congested</span> tonsils, soft palate</li>\n<li>Uvula pushed to the opposite side with bulging soft palate</li>\n<li><strong>No visible neck <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> seen</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Contrast-enhanced CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> to show <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> and extent</li>\n<li>Needle <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> for bacterial culture and sensitivity testing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Conservative:</strong> IV fluids, Analgesics, IV antibiotics, Oral <span class=\"customMeta\" data-dictid=\"15fa752a4f1692777189fe275abf3f\">hygiene</span> (hydrogen <span class=\"customMeta\" data-dictid=\"7e35dc67351692777195c0be6eee0b\">peroxide</span> or <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> mouthwash)</li>\n<li>Incision and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> for abscess</li>\n<li><strong>Surgical:</strong> Interval <span class=\"customMeta\" data-dictid=\"68899ab3a11692777200d8823b50d8\">tonsillectomy</span> (after 4–6 weeks)/ Hot <span class=\"customMeta\" data-dictid=\"68899ab3a11692777200d8823b50d8\">tonsillectomy</span> (Tonsillectomy consecutively along with I&amp;D)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parapharyngeal abscess/ Laryngeal edema</li>\n<li>Pneumonitis or lung abscess/ Septicaemia</li>\n<li>Jugular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/RhTrJCtcpzjn2PjboUPx1746078598.mp3", "video": ""}, {"text": "A 45-year-old male presents with difficulty swallowing, a bulge in the pharynx behind the posterior pillar, and swelling in the parotid region. He also exhibits paralysis of cranial nerves IX, X, XI, and XII. What is the diagnosis?", "options": [{"label": "A", "text": "Parapharyngeal abscess in the anterior compartment", "correct": false}, {"label": "B", "text": "Parapharyngeal abscess in the posterior compartment", "correct": true}, {"label": "C", "text": "Parapharyngeal abscess in the medial compartment", "correct": false}, {"label": "D", "text": "Parapharyngeal abscess in the lateral compartment", "correct": false}], "correct_answer": "B. Parapharyngeal abscess in the posterior compartment", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0QX3a2YvS8pDjG0UsGc71738643552.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parapharyngeal Space</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pyramidal in shape</li>\n<li>Base: skull</li>\n<li>Apex: <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone</li>\n<li>Medial: <span class=\"customMeta\" data-dictid=\"b000e5814a16927771839da6be2d4f\">buccopharyngeal</span> fascia</li>\n<li>Posterior: <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> fascia</li>\n<li>Lateral: <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> muscle, mandible, deep surface of <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> gland</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"326\" src=\"https://image.prepladder.com/content/0QX3a2YvS8pDjG0UsGc71738643552.png\" width=\"500\"/></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aetiology of Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pharynx: Acute/chronic infections (tonsil, adenoid), <span class=\"customMeta\" data-dictid=\"61ec30ed2a16927771951418b5c9f5\">peritonsillar</span> abscess</li>\n<li>Dental infections: usually lower last molars</li>\n<li>Ear: Bezold abscess, petrositis</li>\n<li>Infections of other spaces: Parotid, retropharyngeal, and <span class=\"customMeta\" data-dictid=\"0ea98ca24a1692777199dc9203d700\">submaxillary</span> spaces</li>\n<li>External trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Odynophagia</li>\n<li>Sore throat</li>\n<li>Torticollis</li>\n<li>Signs of toxaemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Compartment-wise symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anterior compartment-anterior to <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process. <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> here causes:\n\t\t\t\t<ul>\n<li>Prolapse of <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> and <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> fossa</li>\n<li>Trismus</li>\n<li>External <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> behind angle of jaw</li>\n</ul>\n</li>\n<li><strong>Posterior compartment</strong>-posterior to <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process. <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> here causes:\n\t\t\t\t<ul>\n<li><strong>Bulge of <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">pharynx</span> behind <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"711a7039b116927771952962024d86\">pillar</span> </strong></li>\n<li><strong>Paralysis of CN IX, X, XI, XII, and <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> chain</strong></li>\n<li><strong>Parotid region <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> </strong></li>\n<li>Minimal <span class=\"customMeta\" data-dictid=\"60defa6790169277720059582a2772\">trismus</span> or <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> prolapse</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Systemic antibiotic</li>\n<li>Drainage of abscess</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Jt6tfnR5SZWK8fiZd4H01744912326.mp3", "video": ""}, {"text": "A 35-year-old man presents with a 5-day history of sore throat, difficulty swallowing, and neck pain. On examination, there is a unilateral bulge in the posterior pharyngeal wall and neck stiffness with limited movement. A lateral neck X-ray reveals a widened prevertebral shadow. What is the etiology?", "options": [{"label": "A", "text": "Penetrating injury to posterior pharyngeal wall", "correct": true}, {"label": "B", "text": "TB infection of cervical spine", "correct": false}, {"label": "C", "text": "Spread of infection from retropharyngeal lymph node", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Penetrating injury to posterior pharyngeal wall", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4QtbbACP3LLRdQZujJ061738643622.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Retropharyngeal space</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Location: Behind the pharynx, between the <span class=\"customMeta\" data-dictid=\"b000e5814a16927771839da6be2d4f\">buccopharyngeal</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> and <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> fascia.</li>\n<li>Extent: From the base of the skull to the <span class=\"customMeta\" data-dictid=\"6c076ff67d1692777183dff2a71da1\">bifurcation</span> of the trachea.</li>\n<li>Divisions: Two <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> compartments (spaces of Gillette) divided by a <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> raphe.</li>\n<li>Communication: with <span class=\"customMeta\" data-dictid=\"161110ecdc16927771941c70d7bcad\">parapharyngeal</span> space</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Aetiology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Children under 3 years (common): <span class=\"customMeta\" data-dictid=\"56a39e9dae169277719923b12d72d1\">suppuration</span> of <span class=\"customMeta\" data-dictid=\"c2e956a8441692777197ea505fc27d\">retropharyngeal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes from infections in adenoids, nasopharynx, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> sinuses, or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity.</li>\n<li>Adults: <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> injuries to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall or <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> esophagus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical Features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dysphagia </strong></li>\n<li>Breathing difficulty</li>\n<li>Stridor</li>\n<li>Croupy cough</li>\n<li><strong>Torticollis</strong></li>\n<li><strong>Unilateral bulge in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>X-ray neck <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> view shows widened <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> shadow, </strong>sometimes even the presence of gas</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"Le L, Alomari A, Kearns C, et al.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/retropharyngeal-abscess\" data-tags=\"\" height=\"573\" src=\"https://image.prepladder.com/content/4QtbbACP3LLRdQZujJ061738643622.png\" width=\"500\"/></p>\n<ul>\n<li>Contrast-enhanced <span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\">CT scan</span> reveals the extent of the abscess</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Incision and drainage</li>\n<li>Systemic antibiotics</li>\n<li>Tracheostomy if needed</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/pnZknNhnAMJ9iJGk7vvz1744911865.mp3", "video": ""}, {"text": "A 40-year-old male with a history of untreated tuberculosis presents with mild throat discomfort and difficulty in swallowing. Examination reveals a central fluctuant swelling in the posterior pharyngeal wall, and X-rays confirm caries of the cervical spine. What is the diagnosis?", "options": [{"label": "A", "text": "Prevertebral abscess", "correct": true}, {"label": "B", "text": "Retropharyngeal abscess", "correct": false}, {"label": "C", "text": "Parapharyngeal abscess", "correct": false}, {"label": "D", "text": "Peritonsillar abscess", "correct": false}], "correct_answer": "A. Prevertebral abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GfOiIhfTlup8ecv1teZZ1738643752.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevertebral space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extent: <span class=\"customMeta\" data-dictid=\"0c19a6573b16927771823ff8450a4a\">Base of skull</span> to coccyx</li>\n<li>Location: Between <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> on one side and <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> muscles and the <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> on the other</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tubercular in nature, caused by:\n\t\t\t\t<ul>\n<li><strong>Caries of the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine (central <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> behind <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> fascia)</strong></li>\n<li>Tuberculous infection of <span class=\"customMeta\" data-dictid=\"c2e956a8441692777197ea505fc27d\">retropharyngeal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes (unilateral <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> behind <span class=\"customMeta\" data-dictid=\"b000e5814a16927771839da6be2d4f\">buccopharyngeal</span> fascia)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Throat discomfort</strong></li>\n<li><strong>Mild dysphagia</strong></li>\n<li><strong>Fluctuant <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall, either centrally</strong> or on one side of midline</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Incision and drainage</li>\n<li>Antitubercular therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Retropharyngeal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prevertebral </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location of the space </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Behind the pharynx, between the <span class=\"customMeta\" data-dictid=\"b000e5814a16927771839da6be2d4f\">buccopharyngeal</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> and <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> fascia, extending from the base of the skull to the <span class=\"customMeta\" data-dictid=\"6c076ff67d1692777183dff2a71da1\">bifurcation</span> of the trachea.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> on one side and <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> muscles and the <span class=\"customMeta\" data-dictid=\"dac7b2041a1692777196c770b6611d\">prevertebral</span> <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> on the other, extenting from the <span class=\"customMeta\" data-dictid=\"0c19a6573b16927771823ff8450a4a\">base of skull</span> to coccyx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Children under 3 years (common)-suppuration of <span class=\"customMeta\" data-dictid=\"c2e956a8441692777197ea505fc27d\">retropharyngeal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n<li>Adults-penetrating injuries to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall or <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> esophagus.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tubercular in nature, caused by: <span class=\"customMeta\" data-dictid=\"382abada90169277718335a73c469a\">Caries</span> of the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> spine or <span class=\"customMeta\" data-dictid=\"a50c41365a1692777201501cb6b378\">tuberculous</span> infection of <span class=\"customMeta\" data-dictid=\"c2e956a8441692777197ea505fc27d\">retropharyngeal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dysphagia</li>\n<li>Breathing difficulty</li>\n<li>Stridor</li>\n<li>Croupy cough</li>\n<li>Torticollis</li>\n<li>Unilateral bulge in the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Throat discomfort</li>\n<li>Mild dysphagia</li>\n<li>Fluctuant <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall, either centrally or on one side of midline</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aTa7QkLgDhLCwfb9QUq51744911434.mp3", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 19 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 46 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following nerves is responsible for referred otalgia from tonsillitis?", "options": [{"label": "A", "text": "Glossopharyngeal nerve", "correct": true}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Trigeminal nerve", "correct": false}, {"label": "D", "text": "Vagus nerve", "correct": false}], "correct_answer": "A. Glossopharyngeal nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Glossopharyngeal nerv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the likely cause for the complaints of a 9-year-old boy presenting with right ear pain, difficulty in opening the mouth, painful swallowing, and fever, when the oral cavity examination shows no abnormalities in the external facial examination?", "options": [{"label": "A", "text": "Pharyngitis", "correct": false}, {"label": "B", "text": "Parotid abscess", "correct": false}, {"label": "C", "text": "Bezold’s Abscess", "correct": false}, {"label": "D", "text": "Quinsy", "correct": true}], "correct_answer": "D. Quinsy", "question_images": ["https://image.prepladder.com/content/qIcoRXIvdxP6W4eKEA9F1745219997.png"], "explanation_images": [], "explanation": "<p>Correct Answer D - Qu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the structure shown in this endoscopic image of the nasopharynx.", "options": [{"label": "A", "text": "Sinus of Morgagni", "correct": false}, {"label": "B", "text": "Passavant’s ridge", "correct": false}, {"label": "C", "text": "Fossa of Rossenmuller", "correct": true}, {"label": "D", "text": "Rathke’s pouch", "correct": false}], "correct_answer": "C. Fossa of Rossenmuller", "question_images": ["https://image.prepladder.com/content/VoUqDB3DY6DcVTEVLKX11746705614.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fossa of Rosenmüller</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deep <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> behind the <strong>torus tubarius</strong>, <strong>common site of <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sinus of Morgagni</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gap between the <strong>base of the skull and superior pharyngeal <span class=\"customMeta\" data-dictid=\"717915c3211692777185522b946dc5\">constrictor</span> muscle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Passavant’s Ridge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscular ridge formed by the <strong>superior pharyngeal constrictor</strong>, involved in <span class=\"customMeta\" data-dictid=\"35a7cfc3341692777201b27c58dc6d\">velopharyngeal</span> closure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rathke’s Pouch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Embryological <span class=\"customMeta\" data-dictid=\"bead1cecfa16927771979940742ada\">remnant</span> from which the <strong>anterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland</strong> develops</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old girl is brought by her mother, with the complaint that the child is experiencing difficulties breathing through her nose. The girl's face appears elongated and lacks expression, and her mouth remains open. Upon examination, it is observed that she has a palate with a high arch and her upper teeth are crowded. An X-ray image is provided for reference. Based on these findings, what is the most probable diagnosis?", "options": [{"label": "A", "text": "Lingual tonsils", "correct": false}, {"label": "B", "text": "Quinsy", "correct": false}, {"label": "C", "text": "Tonsillar hypertrophy", "correct": false}, {"label": "D", "text": "Adenoid hypertrophy", "correct": true}], "correct_answer": "D. Adenoid hypertrophy", "question_images": ["https://image.prepladder.com/content/4tOI4ltoaH2Mh1H9Px4v1747981666.png"], "explanation_images": [], "explanation": "<p>Correct Answer D- &lt;span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\"&gt;Adenoid&lt;/span&gt; hypertrophy.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mark the false statement :", "options": [{"label": "A", "text": "Ansa cervicalis lies on the posterior wall of carotid sheath", "correct": false}, {"label": "B", "text": "Carotid sheath is formed by investing layer of deep cervical fascia", "correct": false}, {"label": "C", "text": "Sympathetic chain lies between internal carotid artery and internal jugular vein", "correct": true}, {"label": "D", "text": "Common carotid artery divides at the level of lower border of thyroid cartilage", "correct": false}], "correct_answer": "C. Sympathetic chain lies between internal carotid artery and internal jugular vein", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<thead>\n<tr>\n<th>Structure</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Contents</td>\n<td>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, Internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">jugular</span> vein, <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">Vagus</span> nerve (CN X)</td>\n</tr>\n<tr>\n<td>Formation</td>\n<td>Formed by the <span class=\"customMeta\" data-dictid=\"73b3d4c73416927771905a7b0fab77\">investing</span> layer of deep <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> fascia</td>\n</tr>\n<tr>\n<td>Location</td>\n<td>Located in the neck, on both sides of the trachea</td>\n</tr>\n<tr>\n<td>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">Carotid</span> Artery</td>\n<td>Ascends within the sheath, bifurcates into internal and external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> arteries at the level of the upper border of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> cartilage</td>\n</tr>\n<tr>\n<td>Internal <span class=\"customMeta\" data-dictid=\"af7ff6c5fd1692777190f88c20b21b\">Jugular</span> Vein</td>\n<td>Lies adjacent to the common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, carrying deoxygenated blood from the brain, face, and neck</td>\n</tr>\n<tr>\n<td>Vagus Nerve (CN X)</td>\n<td>Travels alongside the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> and <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> within the sheath, involved in <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> and various functions in the head and neck</td>\n</tr>\n<tr>\n<td>Sympathetic Chain</td>\n<td>Located <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to the <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> structures, part of the <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> nervous system responsible for fight-or-flight responses</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20 year old female patient presented with throat pain and difficulty in swallowing. On examination, her right tonsil was found to be congested and uvula pushed to opposite side, left side tonsil was normal, what could be the diagnosis ?", "options": [{"label": "A", "text": "Retropharyngeal abscess", "correct": false}, {"label": "B", "text": "Acute parenchymatous tonsillitis", "correct": false}, {"label": "C", "text": "Quinsy", "correct": true}, {"label": "D", "text": "Parapharyngeal abscess", "correct": false}], "correct_answer": "C. Quinsy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cJ6pZTozuAam7lZce28z1713332544.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with a 2 day history of fever and difficulty in swallowing. On examination there was swelling seen in the oropharynx pushing tonsil to midline and swelling over the upper part of neck . What is the most likely diagnosis:", "options": [{"label": "A", "text": "Quinsy", "correct": false}, {"label": "B", "text": "Parapharyngeal abscess", "correct": true}, {"label": "C", "text": "Retropharyngeal abscess", "correct": false}, {"label": "D", "text": "Tonsillitis", "correct": false}], "correct_answer": "B. Parapharyngeal abscess", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5jbbHDF35QGYMHrYRYca1713337125.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Deep lobe of parotid gland swelling presents at", "options": [{"label": "A", "text": "Below the ear lobe", "correct": false}, {"label": "B", "text": "Cheek", "correct": false}, {"label": "C", "text": "Temporal lobe", "correct": false}, {"label": "D", "text": "Parapharyngeal Space", "correct": true}], "correct_answer": "D. Parapharyngeal Space", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Parotid gland is supplied by which nerve?", "options": [{"label": "A", "text": "Facial Nerve", "correct": false}, {"label": "B", "text": "Glossopharyngeal", "correct": true}, {"label": "C", "text": "Vagus Nerve", "correct": false}, {"label": "D", "text": "Hypoglossal Nerve", "correct": false}], "correct_answer": "B. Glossopharyngeal", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which instrument is shown below?", "options": [{"label": "A", "text": "Tongue depressor", "correct": true}, {"label": "B", "text": "Doyen retractor", "correct": false}, {"label": "C", "text": "Self-retaining retractor", "correct": false}, {"label": "D", "text": "Langenbeck's retractor", "correct": false}], "correct_answer": "A. Tongue depressor", "question_images": ["https://image.prepladder.com/content/2mR5dupKnRXzcGAsXr8Z1713337395.png"], "explanation_images": ["https://image.prepladder.com/content/0uPCAsURnnOptIyoLQCL1713337460.png", "https://image.prepladder.com/content/FbLHlDjbZkFVaMJcK9nk1713337477.png", "https://image.prepladder.com/content/wCIhdp9wsZNeV50zjBIl1713337491.png", "https://image.prepladder.com/content/q9dW6ewGS8dpMOce0aNC1713337504.png", "https://image.prepladder.com/content/drTV25jvOLhmR3ZmPKFH1713337557.png"], "explanation": "<p>Correct option A.\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Langenbeck’s </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Morris</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Doyen’s</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Handle</strong></p>\n</td>\n<td>\n<p>Fenestrated</p>\n</td>\n<td>\n<p>Fenestrated</p>\n</td>\n<td>\n<p>No fenestration</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Blade</strong></p>\n</td>\n<td>\n<p>Wide</p>\n</td>\n<td>\n<p>Wider &amp; more curved</p>\n</td>\n<td>\n<p>More curved inside</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Tip</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>More curved</p>\n</td>\n<td>\n<p>More curved</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent presentation of nasopharyngeal carcinoma?", "options": [{"label": "A", "text": "Epistaxis", "correct": false}, {"label": "B", "text": "Headache", "correct": false}, {"label": "C", "text": "Nasal obs", "correct": false}, {"label": "D", "text": "Cervical lymphadenopathy", "correct": true}], "correct_answer": "D. Cervical lymphadenopathy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is not true about Frey's Syndrome?", "options": [{"label": "A", "text": "Gustatory sweating", "correct": false}, {"label": "B", "text": "Aberrant misdirection of parasympathetic fibers of auriculotemporal nerve", "correct": false}, {"label": "C", "text": "Botulinum toxin is one of the treatment suggested", "correct": false}, {"label": "D", "text": "Less chances with enucleation than paratidectomy", "correct": true}], "correct_answer": "D. Less chances with enucleation than paratidectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A senior resident in the hospital is performing the following clinical examination, as shown in the image below. Which of the following structures will not be visible to him?", "options": [{"label": "A", "text": "Adenoids", "correct": false}, {"label": "B", "text": "Arytenoids", "correct": true}, {"label": "C", "text": "Torus tubarius", "correct": false}, {"label": "D", "text": "Upper surface of soft palate", "correct": false}], "correct_answer": "B. Arytenoids", "question_images": ["https://image.prepladder.com/notes/GUdiFpz7DSk2IHf0D5j41746599684.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is true about Torus tubarius, which is formed by the cartilaginous part of the eustachian tube?", "options": [{"label": "A", "text": "Associated with pharyngeal bursitis", "correct": false}, {"label": "B", "text": "Most common site of carcinoma nasopharynx", "correct": false}, {"label": "C", "text": "mucosal elevation in the lateral wall of the nasopharynx", "correct": true}, {"label": "D", "text": "Gives rise to Rathke's pouch", "correct": false}], "correct_answer": "C. mucosal elevation in the lateral wall of the nasopharynx", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LtMVLlfSWd0phzneTjbf1713336768.png"], "explanation": "<p> Correct Option C: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis of a patient who has a two-day history of fever, with a neck swelling and displacement of one tonsil towards the midline upon examination?", "options": [{"label": "A", "text": "Quinsy", "correct": false}, {"label": "B", "text": "Parapharyngeal abscess", "correct": true}, {"label": "C", "text": "Retropharyngeal abscess", "correct": false}, {"label": "D", "text": "Tonsillitis", "correct": false}], "correct_answer": "B. Parapharyngeal abscess", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Common Symptoms</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Quinsy (Peritonsillar Abscess)</p>\n</td>\n<td>\n<p>Collection of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> between the <span class=\"customMeta\" data-dictid=\"e670f25fb7169277720087be88cc56\">tonsillar</span> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> and surrounding tissues</p>\n</td>\n<td>\n<p>Severe throat pain, difficulty swallowing, \"hot potato\" voice</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Parapharyngeal Abscess</p>\n</td>\n<td>\n<p>Infection in the space behind the <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> and next to the pharynx</p>\n</td>\n<td>\n<p>Neck swelling, <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of tonsil, possible difficulty swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Retropharyngeal Abscess</p>\n</td>\n<td>\n<p>Infection in the space behind the <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">pharynx</span> and in front of the <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> vertebrae</p>\n</td>\n<td>\n<p>Neck pain, difficulty swallowing, stiff neck</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tonsillitis</p>\n</td>\n<td>\n<p>Inflammation of the tonsils</p>\n</td>\n<td>\n<p>Sore throat, difficulty swallowing, fever</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "From the first pharyngeal arch, which muscle originates among the options provided?", "options": [{"label": "A", "text": "Stapedius muscle", "correct": false}, {"label": "B", "text": "Anterior belly of digastric muscle", "correct": true}, {"label": "C", "text": "Posterior belly of digastric muscle", "correct": false}, {"label": "D", "text": "Stylopharyngeus", "correct": false}], "correct_answer": "B. Anterior belly of digastric muscle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B- Anterior belly of &lt;span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\"&gt;digastric&lt;/span&gt; mu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pharyngeal Arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structures Derived</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscles of <span class=\"customMeta\" data-dictid=\"7beec9567a1692777191ec123e0989\">Mastication</span> (Masseter, Temporalis, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> Pterygoids)</li>\n<li>Anterior Belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> Muscle</li>\n<li>Mylohyoid Muscle</li>\n<li>Tensor Tympani Muscle</li>\n<li>Tensor Veli Palatini Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Second Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">Facial</span> Expression</li>\n<li>Stylohyoid Muscle</li>\n<li>Posterior Belly of <span class=\"customMeta\" data-dictid=\"25d67c73f516927771861326d5044c\">Digastric</span> Muscle</li>\n<li>Stapedius Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Third Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stylopharyngeus Muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fourth and Sixth Pharyngeal Arch</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscles of the <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">Pharynx</span> (except Stylopharyngeus)</li>\n<li>Muscles of the Larynx</li>\n<li>Cricothyroid Muscle</li>\n<li>Levator Veli Palatini Muscle</li>\n<li>Constrictors of the <span class=\"customMeta\" data-dictid=\"fbab90346f16927771952f02d620c9\">Pharynx</span> (Superior, Middle, and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Constrictors)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle is responsible for the spasm causing trismus in parapharyngeal abscess?", "options": [{"label": "A", "text": "Medial pterygoid", "correct": true}, {"label": "B", "text": "Lateral pterygoid", "correct": false}, {"label": "C", "text": "Masseter", "correct": false}, {"label": "D", "text": "Temporalis", "correct": false}], "correct_answer": "A. Medial pterygoid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the subsequent options does not represent a premalignant lesion or condition?", "options": [{"label": "A", "text": "Chronic hypertrophic candidiasis", "correct": true}, {"label": "B", "text": "Oral submucosal fibrosis", "correct": false}, {"label": "C", "text": "Lichen planus", "correct": false}, {"label": "D", "text": "Leukoplakia", "correct": false}], "correct_answer": "A. Chronic hypertrophic candidiasis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Premalignant Lesion/Condition</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Associated Risk of Cancer</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Chronic hypertrophic candidiasis</p>\n</td>\n<td>\n<p>Fungal infection caused by <span class=\"customMeta\" data-dictid=\"f54d5c5cf11692777183318f259e5f\">Candida</span> species</p>\n</td>\n<td>\n<p>Not considered premalignant</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oral <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> fibrosis</p>\n</td>\n<td>\n<p>Chronic condition with <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> bands in the oral cavity</p>\n</td>\n<td>\n<p>Increased risk of oral <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lichen planus</p>\n</td>\n<td>\n<p>Autoimmune condition affecting skin and oral mucosa</p>\n</td>\n<td>\n<p>Associated with increased risk of oral <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> in some cases</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Leukoplakia</p>\n</td>\n<td>\n<p>White or gray patches on <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes, including oral mucosa</p>\n</td>\n<td>\n<p>Considered a <span class=\"customMeta\" data-dictid=\"feb5b6aaeb16927771964c9d7c801c\">premalignant</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with potential for oral cancer development</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following muscles is not innervated by the hypoglossal nerve?", "options": [{"label": "A", "text": "Palatoglossus", "correct": true}, {"label": "B", "text": "Styloglossus", "correct": false}, {"label": "C", "text": "Genioglossus", "correct": false}, {"label": "D", "text": "Hyoglossus", "correct": false}], "correct_answer": "A. Palatoglossus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Muscle</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Nerve Supply</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Genioglossus</p>\n</td>\n<td>\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hyoglossus</p>\n</td>\n<td>\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Styloglossus</p>\n</td>\n<td>\n<p>Hypoglossal nerve (CN XII)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Palatoglossus</p>\n</td>\n<td>\n<p>Vagus nerve (CN X)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle among the options provided functions as an accessory muscle in the process of mastication?", "options": [{"label": "A", "text": "Buccinator", "correct": true}, {"label": "B", "text": "Masseter", "correct": false}, {"label": "C", "text": "Medial pterygoid", "correct": false}, {"label": "D", "text": "Lateral pterygoid", "correct": false}], "correct_answer": "A. Buccinator", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A\n<table>\n<thead>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Muscle</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Actions</strong></p>\n</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>\n<p>Buccinator</p>\n</td>\n<td>\n<p>Compresses cheeks, assists in chewing and swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Palatoglossus</p>\n</td>\n<td>\n<p>Elevates the back of the tongue, assists in swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mylohyoid</p>\n</td>\n<td>\n<p>Elevates the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone and floor of the mouth, assists in swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anterior belly of the digastric</p>\n</td>\n<td>\n<p>Depresses the mandible, elevates the <span class=\"customMeta\" data-dictid=\"3e441c1e2d16927771892158232a2c\">hyoid</span> bone</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient comes with an ulcer on the tongue with a duration of 3 months. On examination, there is a 3.5cm x 2.5 cm lesion with induration of 8mm. There was no lymphadenopathy. What is the stage of this lesion according to 8the AJCC guidelines ?", "options": [{"label": "A", "text": "Stage I", "correct": false}, {"label": "B", "text": "Stage II", "correct": true}, {"label": "C", "text": "Stage III", "correct": false}, {"label": "D", "text": "Stage IV", "correct": false}], "correct_answer": "B. Stage II", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Stage</strong></p>\n</td>\n<td>\n<p><strong>Tumor (T)</strong></p>\n</td>\n<td>\n<p><strong>Lymph Nodes (N)</strong></p>\n</td>\n<td>\n<p><strong>Metastasis (M)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Stage 0</strong></p>\n</td>\n<td>\n<p><strong>Tis: <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> in situ</strong></p>\n</td>\n<td>\n<p><strong>N0: No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</strong></p>\n</td>\n<td>\n<p><strong>M0: No distant metastasis</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Stage I</strong></p>\n</td>\n<td>\n<p><strong>T1: Tumor ≤ 2 cm in greatest dimension</strong></p>\n</td>\n<td>\n<p><strong>N0: No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</strong></p>\n</td>\n<td>\n<p><strong>M0: No distant metastasis</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Stage II</strong></p>\n</td>\n<td>\n<p><strong>T2: Tumor &gt; 2 cm but ≤ 4 cm in greatest dimension</strong></p>\n</td>\n<td>\n<p><strong>N0: No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</strong></p>\n</td>\n<td>\n<p><strong>M0: No distant metastasis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stage III</p>\n</td>\n<td>\n<p>T3: Tumor &gt; 4 cm in greatest dimension</p>\n</td>\n<td>\n<p>N0: No regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n<td>\n<p>M0: No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>or</p>\n</td>\n<td>\n<p>or</p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>T1/T2: Tumor with <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</strong></p>\n</td>\n<td>\n<p><strong>N1: <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> in a single <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</strong></p>\n</td>\n<td>\n<p><strong>M0: No distant metastasis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stage IVA</p>\n</td>\n<td>\n<p>T4a: Tumor invades adjacent structures</p>\n</td>\n<td>\n<p>N0/N1/N2: Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n<td>\n<p>M0: No distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>or</p>\n</td>\n<td>\n<p>or</p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p>T1/T2/T3: Tumor with <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</p>\n</td>\n<td>\n<p>N2: Multiple <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> or <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastases</p>\n</td>\n<td>\n<p>M0: No distant metastasis</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>metastasis</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stage IVB</p>\n</td>\n<td>\n<p>T4b: Tumor invades masticator space, <span class=\"customMeta\" data-dictid=\"b90cf96a041692777196f47b64db6d\">pterygoid</span> plates,</p>\n</td>\n<td>\n<p>Any N: Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n<td>\n<p>M0: No distant metastasis</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>or skull base</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stage IVC</p>\n</td>\n<td>\n<p>Any T: Tumor of any size</p>\n</td>\n<td>\n<p>Any N: Regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> metastasis</p>\n</td>\n<td>\n<p>M1: Distant metastasis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with oral cavity findings are seen in the image below. He is a smoker. What would you choose as your next step in the management of this patient ?", "options": [{"label": "A", "text": "Give corticosteroids", "correct": false}, {"label": "B", "text": "Cessation of smoking and do biopsy", "correct": true}, {"label": "C", "text": "Lifestyle modification", "correct": false}, {"label": "D", "text": "Injection vitamin B12", "correct": false}], "correct_answer": "B. Cessation of smoking and do biopsy", "question_images": ["https://image.prepladder.com/content/gOizN9PWrbrCGreTaKVK1713336938.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Lesion</strong></p>\n</td>\n<td>\n<p><strong>Description</strong></p>\n</td>\n<td>\n<p><strong>Risk Category</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Leukoplakia</p>\n</td>\n<td>\n<p>White patch or <span class=\"customMeta\" data-dictid=\"af71c1668e169277719542cf8f1364\">plaque</span> that cannot be scraped off</p>\n</td>\n<td>\n<p>Potentially premalignant</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Erythroplakia</p>\n</td>\n<td>\n<p>Smooth, red velvety patch in the oral cavity</p>\n</td>\n<td>\n<p>High risk for <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> or malignancy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oral <span class=\"customMeta\" data-dictid=\"b49bba8e8a16927771997b281fd66a\">submucous</span> fibrosis</p>\n</td>\n<td>\n<p>Chronic, progressive fibrotic condition</p>\n</td>\n<td>\n<p>Precancerous condition</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Verrucous hyperplasia</p>\n</td>\n<td>\n<p>Proliferative, wart-like growth in the oral cavity</p>\n</td>\n<td>\n<p>Associated with <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Actinic cheilitis</p>\n</td>\n<td>\n<p>Sun-induced changes in the lower lip</p>\n</td>\n<td>\n<p>Premalignant condition</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oral <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> planus</p>\n</td>\n<td>\n<p>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> condition affecting mucosa</p>\n</td>\n<td>\n<p>Increased risk of <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dysplastic nevus</p>\n</td>\n<td>\n<p>Atypical mole with potential for <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation</p>\n</td>\n<td>\n<p>Increased risk for melanoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following features will not be manifested in an infection of the post-styloid compartment of the parapharyngeal space ?", "options": [{"label": "A", "text": "Trismus", "correct": true}, {"label": "B", "text": "Vocal cord palsy", "correct": false}, {"label": "C", "text": "Parotid swelling", "correct": false}, {"label": "D", "text": "Horner’s syndrome", "correct": false}], "correct_answer": "A. Trismus", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<thead>\n<tr>\n<th>Aspect</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Location</td>\n<td>Located deep within the <span class=\"customMeta\" data-dictid=\"161110ecdc16927771941c70d7bcad\">parapharyngeal</span> space, behind the <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">styloid</span> process of the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone.</td>\n</tr>\n<tr>\n<td>Common Causes</td>\n<td>- Spread of infections from adjacent structures (e.g., tonsils, middle ear). - <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">Abscess</span> formation. - Rarely, <span class=\"customMeta\" data-dictid=\"c82360aadd16927771936d67fa30a4\">neoplastic</span> conditions.</td>\n</tr>\n<tr>\n<td>Clinical Manifestations</td>\n<td>- Severe <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat. - <span class=\"customMeta\" data-dictid=\"60defa6790169277720059582a2772\">Trismus</span> (difficulty in mouth opening). - Pain on swallowing. - Neck pain. - Fever and <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms. - <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">Cranial</span> nerve involvement (e.g., vocal cord palsy).</td>\n</tr>\n<tr>\n<td>Imaging Findings</td>\n<td>- CT or <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> scans may reveal <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation or <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> in the post-styloid compartment.</td>\n</tr>\n<tr>\n<td>Treatment</td>\n<td>- Antibiotics to manage infection. - <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">Drainage</span> of <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> if present. - Pain management. - Management of any complications (e.g., <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> compromise).</td>\n</tr>\n<tr>\n<td>Potential Complications</td>\n<td>- <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> compromise due to severe <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or abscess. - Extension of infection to adjacent spaces. - <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">Cranial</span> nerve palsies (e.g., vocal cord palsy).</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 10-year-old child with symptoms of throat pain, fever, and ear pain, the diagnosis is recurrent tonsillitis. Which specific nerve is associated with the ear pain in this patient?", "options": [{"label": "A", "text": "Tympanic branch of the glossopharyngeal nerve", "correct": true}, {"label": "B", "text": "Greater auricular nerve", "correct": false}, {"label": "C", "text": "Auriculotemporal nerve", "correct": false}, {"label": "D", "text": "Auricular branch of the vagus nerve", "correct": false}], "correct_answer": "A. Tympanic branch of the glossopharyngeal nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure given in the image below", "options": [{"label": "A", "text": "Buccopharyngeal fascia", "correct": true}, {"label": "B", "text": "Prevertebral fascia", "correct": false}, {"label": "C", "text": "Pharyngobasilar fascia", "correct": false}, {"label": "D", "text": "Alar fascia", "correct": false}], "correct_answer": "A. Buccopharyngeal fascia", "question_images": ["https://image.prepladder.com/content/NuyPAK8WJt3XFzSAuuTw1741087227.png"], "explanation_images": ["https://image.prepladder.com/content/LgryenCQv761t9dxV5et1741063734.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Impaired gag reflex is caused by a lesion in which of the following cranial nerves?", "options": [{"label": "A", "text": "CN V and VI", "correct": false}, {"label": "B", "text": "CN X and XI", "correct": false}, {"label": "C", "text": "CN IX and X", "correct": true}, {"label": "D", "text": "CN VII and VIII", "correct": false}], "correct_answer": "C. CN IX and X", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - CN IX and X\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Oropharynx, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> 1/3<sup>rd</sup> of tongue, tonsils, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Glossopharyngeal nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Larynx and hypopharynx, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> oesophagus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vagus nerve</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the device shown in the image?", "options": [{"label": "A", "text": "Nasopharyngeal airway", "correct": true}, {"label": "B", "text": "Laryngeal Mask Airway (LMA)", "correct": false}, {"label": "C", "text": "NG tube", "correct": false}, {"label": "D", "text": "Oropharyngeal tube", "correct": false}], "correct_answer": "A. Nasopharyngeal airway", "question_images": ["https://image.prepladder.com/content/nkHorIkD8cSNYQUew0KJ1724840492.png"], "explanation_images": ["https://image.prepladder.com/content/WxXbMinwPwJBzaIiZQE71724936728.PNG", "https://image.prepladder.com/content/SHgHC7zdHsS9vuPspdF71724936785.png", "https://image.prepladder.com/content/X2ZLKvQOoOkpo3bUYDDB1724936826.png"], "explanation": "<p>Correct Option A - Nasopharyng\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given instrument ?", "options": [{"label": "A", "text": "Montgomery T- tube", "correct": false}, {"label": "B", "text": "Tracheoesophageal prosthesis", "correct": true}, {"label": "C", "text": "BAHA", "correct": false}, {"label": "D", "text": "PORP prosthesis", "correct": false}], "correct_answer": "B. Tracheoesophageal prosthesis", "question_images": ["https://image.prepladder.com/notes/iOYfkHccRLsveWaPfhPj1747661362.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13-year-old boy presents with right-sided nasal obstruction and recurrent epistaxis for the past 6 months. What is the most likely diagnosis?", "options": [{"label": "A", "text": "JNA", "correct": true}, {"label": "B", "text": "Allergic rhinitis", "correct": false}, {"label": "C", "text": "Coagulation disorder", "correct": false}, {"label": "D", "text": "Antrochoanal polyp", "correct": false}], "correct_answer": "A. JNA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - JNA\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which structure is typically involved in causing lower lip paralysis following a parotidectomy?", "options": [{"label": "A", "text": "Facial-cervical branches of FN", "correct": false}, {"label": "B", "text": "Facial-main trunk of FN", "correct": true}, {"label": "C", "text": "Facial-temporal part of FN", "correct": false}, {"label": "D", "text": "Parotid duct", "correct": false}], "correct_answer": "B. Facial-main trunk of FN", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred management for a pediatric patient with symptomatic adenoid hypertrophy causing chronic nasal obstruction and sleep apnea?", "options": [{"label": "A", "text": "Adenoidectomy", "correct": true}, {"label": "B", "text": "Adenoidectomy with grommet insertion", "correct": false}, {"label": "C", "text": "Antibiotic therapy", "correct": false}, {"label": "D", "text": "Watchful waiting", "correct": false}], "correct_answer": "A. Adenoidectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">Adenoid</span> Hypertrophy:</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Medical Management: (For Mild Cases initially)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breathing exercises</li>\n<li>Decongestant <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> drops</li>\n<li>Antihistamines for any <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> allergies</li>\n<li>Topical <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Steroids may reduce <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> size and improve related symptoms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical Intervention: (Adenoidectomy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Traditional Methods: Blind <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> adenoidectomy</strong> remains common, but it has disadvantages, including unpredictable <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and poor access to the <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> adenoid. Hence, <strong>Endoscopic management</strong> is currently preferred.</li>\n<li><strong>Direct Vision Techniques:</strong>\n<ul>\n<li><strong>Suction Diathermy</strong></li>\n<li><strong>Endoscopic Coblation/Microdebridement involves using <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> to visualise and</strong> allows for precise removal of obstructive <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> tissue, addressing the underlying issue directly.</li>\n<li><strong>KTP Laser:</strong> Associated with a higher risk of <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> stenosis, while the gold laser has not shown this risk.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis of the image given below?", "options": [{"label": "A", "text": "Ranula", "correct": true}, {"label": "B", "text": "Pleomorphic adenoma", "correct": false}, {"label": "C", "text": "Ludwig angina", "correct": false}, {"label": "D", "text": "Dermoid cyst", "correct": false}], "correct_answer": "A. Ranula", "question_images": ["https://image.prepladder.com/content/Ki0TeZ36B73Wyq3dIYQ31745998808.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common site of ranula?", "options": [{"label": "A", "text": "Floor of the mouth", "correct": true}, {"label": "B", "text": "Tonsil", "correct": false}, {"label": "C", "text": "Uvula", "correct": false}, {"label": "D", "text": "Cingula", "correct": false}], "correct_answer": "A. Floor of the mouth", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Floor of the mouth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with a mild cold who also has adenoid facies has been identified as having chronic adenoid hypertrophy. Which is the best surgical management for this condition?", "options": [{"label": "A", "text": "Coblator", "correct": true}, {"label": "B", "text": "Microdebrider", "correct": false}, {"label": "C", "text": "Curettage", "correct": false}, {"label": "D", "text": "Breathing exercise and symptomatic treatment", "correct": false}], "correct_answer": "A. Coblator", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked by the yellow arrow in the image.", "options": [{"label": "A", "text": "Fossa of Rosenmuller", "correct": true}, {"label": "B", "text": "Tubal tonsil", "correct": false}, {"label": "C", "text": "Opening of the Eustachian tube", "correct": false}, {"label": "D", "text": "Adenoid", "correct": false}], "correct_answer": "A. Fossa of Rosenmuller", "question_images": ["https://image.prepladder.com/notes/XpcNPqMF25wtclAd20h61745909708.png"], "explanation_images": ["https://image.prepladder.com/notes/wIsZYhSAUeOyitCIKmzt1745909776.jpg"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with Hollman miller's sign in the CT image given below?", "options": [{"label": "A", "text": "Juvenile nasopharyngeal angiofibroma", "correct": true}, {"label": "B", "text": "Maxillary sinusitis", "correct": false}, {"label": "C", "text": "Nasal polyp", "correct": false}, {"label": "D", "text": "Rhinosporidiosis", "correct": false}], "correct_answer": "A. Juvenile nasopharyngeal angiofibroma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations of <span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\">Juvenile</span> <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"dc364f6a301692777181702ff7d53b\">angiofibroma</span> (JNA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contrast-Enhanced CT Scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice</strong>; shows tumor size, location, and bony involvement.</li>\n<li>Pathognomonic sign: Holman-Miller sign (bowing of maxillary wall).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Magnetic <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">Resonance</span> <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> (MRI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Evaluates soft tissue and <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> extension, differentiates between <span class=\"customMeta\" data-dictid=\"a479c9f4081692777187a3308ccd27\">extradural</span> and <span class=\"customMeta\" data-dictid=\"ebcba023d81692777190e9eef5bcc2\">intradural</span> spread.<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Digital <span class=\"customMeta\" data-dictid=\"408be3f8d81692777199619278702d\">Subtraction</span> <span class=\"customMeta\" data-dictid=\"c67cc1bcd3169277718150b3c9d6ab\">Angiography</span> (DSA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Visualizes tumor vascularity, identifies <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> vessels and aids in <span class=\"customMeta\" data-dictid=\"e76ccaf0af1692777196a34b3fb8dc\">preoperative</span> <span class=\"customMeta\" data-dictid=\"27e516f8fe16927771876f99c6b831\">embolization</span> to reduce <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> blood loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nasopharyngoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides a direct view of the tumor, but <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is generally avoided due to high <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> caused by <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">Eustachian</span> tube obstruction; establishes <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> and monitors post-treatment hearing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Biopsy is<strong> contraindicated</strong> due to risk of profuse bleeding.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old was brought to the emergency department with difficulty swallowing for the last few hours. The X-ray is given below. Which is the next best step to manage this patient? [", "options": [{"label": "A", "text": "Bronchoscopy", "correct": false}, {"label": "B", "text": "Esophagoscopy", "correct": true}, {"label": "C", "text": "Tracheostomy", "correct": false}, {"label": "D", "text": "Heimlich's manoeuvre", "correct": false}], "correct_answer": "B. Esophagoscopy", "question_images": ["https://image.prepladder.com/content/3TVJvdAiF8bmD7F8Dq801746427632.png"], "explanation_images": ["https://image.prepladder.com/content/G7PW6pfL6Oa9QQR5scAY1746427665.png", "https://image.prepladder.com/content/Qk8MJveBy8QeKoMkzGga1746427665.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Emergency</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (inability to handle oral secretions)</li>\n<li>Disk batteries</li>\n<li>Sharp-pointed objects</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Immediate <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> removal </strong></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Urgent </strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Blunt objects</li>\n<li>Incomplete obstruction</li>\n<li>Multiple magnets (or single <span class=\"customMeta\" data-dictid=\"883e21a28016927771915738a46f85\">magnet</span> plus another ferromagnetic object within <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> reach)</li>\n<li>Coins</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Endoscopic removal within 12 to 24 hours<strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Non Urgent</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Objects in stomach &gt;2.5cm diameter</li>\n<li>Disc battery in the stomach for up to 48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> if asymptomatic</li>\n<li>Blunt objects that fail to pass the stomach in 3-4 weeks</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">Observation<strong> </strong></td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the next step in managing the symptoms of a 7-year-old child who underwent a tonsillectomy and now presents with snoring, palpitations, mouth breathing, a slight hearing loss, a high arched palate, and a decline in school performance, causing concern to the mother?", "options": [{"label": "A", "text": "a.Adenoidectomy", "correct": false}, {"label": "B", "text": "b.Myringoplasty", "correct": false}, {"label": "C", "text": "c.Adenoidectomy with grommet insertion", "correct": true}, {"label": "D", "text": "d.Conservative management", "correct": false}], "correct_answer": "C. c.Adenoidectomy with grommet insertion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r6HFLal2XjL47UpdyQSb1713332438.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male who is a professional trumpet blower presented with a swelling on the left side of the neck. On examination, there is a gurgling sound compressing the swelling. X-ray of the neck is seen below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pharyngeal pouch", "correct": false}, {"label": "B", "text": "Laryngocele", "correct": true}, {"label": "C", "text": "Trachea-oesophageal fistula", "correct": false}, {"label": "D", "text": "Tonsillar cyst", "correct": false}], "correct_answer": "B. Laryngocele", "question_images": ["https://image.prepladder.com/notes/acoe6s4g05oHIEULfwxD1747897701.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable condition for a 6-year-old child who has not received immunization, presented to the Emergency Room by a concerned mother, experiencing symptoms such as fever, cough, and difficulty breathing? Physical examination reveals the presence of a pseudo membrane on the tonsils that bleeds upon attempted removal, as well as a swollen neck giving a bull-neck appearance.", "options": [{"label": "A", "text": "Infectious mononucleosis", "correct": false}, {"label": "B", "text": "Tonsillitis", "correct": false}, {"label": "C", "text": "Diphtheria", "correct": true}, {"label": "D", "text": "Candidiasis", "correct": false}], "correct_answer": "C. Diphtheria", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following conditions does not result in the development of a grey-white membrane over the tonsils?", "options": [{"label": "A", "text": "Streptococcal tonsillitis", "correct": false}, {"label": "B", "text": "Diphtheria", "correct": false}, {"label": "C", "text": "Ludwig’s angina", "correct": true}, {"label": "D", "text": "Infectious mononucleosis", "correct": false}], "correct_answer": "C. Ludwig’s angina", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Nb3Ln9G0EPZYcKe1cbQ31747902010.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ludwig’s angina- Anatomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Spaces</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It involves three spaces around the mandible: the sublingual, submandibular, and <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> spaces.</p>\n<ul>\n<li><strong>Sublingual space</strong>: Infections here typically arise from the premolars and first molar.</li>\n<li><strong>Submandibular space</strong>: It contains the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> and <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, and connects to both the <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> and <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> spaces.</li>\n<li><strong>Submental space</strong>: Infections in the <span class=\"customMeta\" data-dictid=\"6dc33c9af116927771993596438eb2\">submandibular</span> space can easily spread to the <span class=\"customMeta\" data-dictid=\"a94c9109b016927771997aa2985457\">submental</span> and <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> spaces.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Spaces</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The secondary spaces, known collectively as the masticator space, surround the muscles involved in <span class=\"customMeta\" data-dictid=\"7beec9567a1692777191ec123e0989\">mastication</span> (masseter, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> pterygoid, and temporalis).</li>\n<li>These spaces can become involved due to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> spread of infection from the primary spaces or from a <span class=\"customMeta\" data-dictid=\"8881e191391692777200888db48f0f\">third molar</span> infection.</li>\n<li>The primary clinical feature of masticator space infection is <strong>significant trismus.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image given below is from a chronic smoker’s oral examination. Identify the lesion given.", "options": [{"label": "A", "text": "Erythroplakia", "correct": false}, {"label": "B", "text": "Leukoplakia", "correct": true}, {"label": "C", "text": "Fordyce’s granules", "correct": false}, {"label": "D", "text": "Koplik’s spots", "correct": false}], "correct_answer": "B. Leukoplakia", "question_images": ["https://image.prepladder.com/content/jRDTI7MxpAxxkyd0IUk91747902021.png"], "explanation_images": ["https://image.prepladder.com/content/miibFcYrflq8RsAoDqbl1747902058.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:556px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>White patch on oral mucosa, defined clinically, excluding conditions like <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> planus, candidiasis, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Smoking, tobacco chewing</strong></li>\n<li>Alcohol abuse (especially with smoking)</li>\n<li>Chronic trauma (ill-fitting dentures, cheek bites)</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"b49bba8e8a16927771997b281fd66a\">submucous</span> fibrosis, hyperplastic candidiasis, Plummer-Vinson syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Buccal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (most common in India)</li>\n<li>Oral commissures, floor of mouth, tongue, gingivobuccal sulcus, lip mucosa</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age &amp; Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Men in their 40s are 2-3 times more affected than females.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Homogenous</strong>: Smooth or wrinkled white patch, lower <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n<li><strong>Nodular (speckled)</strong>: White patches on an erythematous base, higher <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n<li><strong>Erosive (erythroleukoplakia)</strong>: Interspersed with red patches, fissures, highest <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignant potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>1-17.5% risk, average 5% <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation</li>\n<li>Higher risk in <span class=\"customMeta\" data-dictid=\"fd29b16a0e1692777186324bd9a553\">dysplastic</span> lesions and certain locations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Remove <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> factors</strong>: Spontaneous <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> in some cases.</li>\n<li><strong>Biopsy</strong>: For lesions with high <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential.</li>\n<li><strong>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or laser/cryotherapy</strong>: For suspicious or small lesions</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary source of arterial supply for the palatine tonsils among the options provided?", "options": [{"label": "A", "text": "Tonsillar branch of the facial artery", "correct": true}, {"label": "B", "text": "Descending palatine branch of maxillary artery", "correct": false}, {"label": "C", "text": "Buccal branch of maxillary artery", "correct": false}, {"label": "D", "text": "Ascending palatine branch of facial artery", "correct": false}], "correct_answer": "A. Tonsillar branch of the facial artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NGiRwiedCD3SBllzFaGk1746095021.png", "https://image.prepladder.com/content/SSBIYgIMU7EB5POXYC4G1746095021.png", "https://image.prepladder.com/content/WmhotZrqcAXsa9fPq3bG1746095021.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anatomy of <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">Palatine</span> tonsils</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral wall of the <span class=\"customMeta\" data-dictid=\"4356afe522169277719436b593e4b1\">oropharynx</span> between the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pillars.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surface Extensions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upwards into the soft palate, downwards into the base of the tongue, and anteriorly into the <span class=\"customMeta\" data-dictid=\"e9ece0007c1692777194ca3031b229\">palatoglossal</span> arch.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medial Surface Epithelium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Stratified <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> with crypts. </strong></li>\n<li>Crypta magna, or <span class=\"customMeta\" data-dictid=\"d567f07dd1169277719021eebd8d64\">intratonsillar</span> cleft, is located near the upper part of the tonsil.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"223\" src=\"https://image.prepladder.com/content/NGiRwiedCD3SBllzFaGk1746095021.png\" width=\"223\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral Surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is covered by a <strong>fibrous <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> separated from the <span class=\"customMeta\" data-dictid=\"2f64b606f6169277720080acdb1d3d\">tonsil</span> bed by loose areolar tissue. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tonsil Bed Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Formed by the <strong>superior constrictor</strong> and <strong>styloglossus muscles.</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"236\" src=\"https://image.prepladder.com/content/SSBIYgIMU7EB5POXYC4G1746095021.png\" width=\"236\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arterial Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Tonsillar branch of the <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> </strong>(main supply)</li>\n<li>Ascending pharyngeal artery</li>\n<li>Ascending <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> artery</li>\n<li>Dorsal <span class=\"customMeta\" data-dictid=\"2d8e6d84411692777191ec7303c17d\">linguae</span> branches of the <span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\">lingual</span> artery</li>\n<li>Descending <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> branch of the maxillary artery.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"236\" src=\"https://image.prepladder.com/content/WmhotZrqcAXsa9fPq3bG1746095021.png\" width=\"236\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Venous Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It drains into the <strong>paratonsillar vein</strong>, which joins the common <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> and the pharyngeal <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> plexus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphatic Drainage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flows into the <strong>upper deep <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> nodes.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sensory Nerve Supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lesser <span class=\"customMeta\" data-dictid=\"1b6ebc94b416927771947d3c404756\">palatine</span> branches of the <span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\">sphenopalatine</span> <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">ganglion</span> (CN V)</strong> and the <strong>glossopharyngeal nerve.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition shown in the image.", "options": [{"label": "A", "text": "Adenoid facies", "correct": true}, {"label": "B", "text": "Goldenhar syndrome", "correct": false}, {"label": "C", "text": "Horse facies", "correct": false}, {"label": "D", "text": "Frog facies", "correct": false}], "correct_answer": "A. Adenoid facies", "question_images": ["https://image.prepladder.com/notes/jZYob9jQ1JxLAiFqGgzf1745401983.png"], "explanation_images": ["https://image.prepladder.com/notes/jZYob9jQ1JxLAiFqGgzf1745401983.png", "https://image.prepladder.com/notes/iJqnavCEovZBoXBEnwyD1745402086.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adenoid Hypertrophy</strong>: (Enlargement of the adenoids)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Physiological Enlargement:</strong> Common in childhood.</li>\n<li><strong>Chronic Conditions:</strong> Recurrent rhinitis, sinusitis, chronic tonsillitis, &amp; allergies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nasal Symptoms:</strong></li>\n</ul>\n<ul>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> leading to <span class=\"customMeta\" data-dictid=\"491e4d8d3f1692777192a47674360b\">mouth breathing</span> and <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties.</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> due to <span class=\"customMeta\" data-dictid=\"a7252280951692777184ad8747c9dd\">choanal</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and chronic rhinitis.</li>\n<li>Sinusitis, Epistaxis &amp; voice changes due to <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction. <strong>(Rhinolalia clausa)</strong></li>\n</ul>\n<ul>\n<li><strong>Aural Symptoms:</strong></li>\n</ul>\n<ul>\n<li>Tubal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> causing retracted <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and CHL.</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media and chronic <span class=\"customMeta\" data-dictid=\"a48a50d87216927771994f1cfe9b7d\">suppurative</span> <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media.</li>\n<li>Otitis media with <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> due to <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> <span class=\"customMeta\" data-dictid=\"22053f7eef1692777187c1142bad20\">eustachian</span> tube obstruction.</li>\n</ul>\n<ul>\n<li><strong>Adenoid Facies:</strong> Characteristic <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> appearance with an <strong>elongated face, open mouth, crowded upper teeth, and high-arched palate.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"EN277\" data-author=\"Luv AgarwalRagni TandonR. KulshresthaAnkita Gupta\" data-hash=\"11229\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Photograph-of-a-patient-with-adenoids-showing-open-mouth-breathing-and-expression-less_fig1_276490718\" data-tags=\"April2025\" height=\"502\" src=\"https://image.prepladder.com/notes/jZYob9jQ1JxLAiFqGgzf1745401983.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"EN276\" data-author=\"NA\" data-hash=\"11230\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"516\" src=\"https://image.prepladder.com/notes/iJqnavCEovZBoXBEnwyD1745402086.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>Pulmonary Hypertension:</strong> Potential due to long-standing <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> obstruction.</li>\n<li><strong>Aprosexia:</strong> Difficulty concentrating</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>External Nose:</strong> Check for skin changes indicating frequent nose rubbing.</li>\n<li><strong>Nasal Assessment: </strong>Halogen light <span class=\"customMeta\" data-dictid=\"286d894b461692777194849ba2b56d\">otoscope</span> is used for simple <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> rhinoscopy<strong>, </strong>which examines the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> but not the adenoids.</li>\n<li><strong>Adenoid Assessment:</strong>\n<ul>\n<li><strong>Nasendoscopy:</strong> For detailed evaluation, a flexible <span class=\"customMeta\" data-dictid=\"318e52e4751692777195acbcdf4551\">pediatric</span> <span class=\"customMeta\" data-dictid=\"e3a3b038c216927771875644f31cc5\">endoscope</span> with <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> anaesthesia is preferred. It provides<strong> an accurate assessment of <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> size in an <span class=\"customMeta\" data-dictid=\"a9f32a257d1692777194caf3b4cf78\">outpatient</span> setting.</strong></li>\n<li><strong>Lateral Soft-Tissue Radiograph:</strong> This is useful when <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> is not tolerated; it correlates well with <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> findings.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Involvement of Jugular foramen leads to which of the following:", "options": [{"label": "A", "text": "Loss of taste from the anterior ⅔ of the tongue", "correct": false}, {"label": "B", "text": "Loss of sensation from the posterior ⅓ of the tongue", "correct": true}, {"label": "C", "text": "Loss of sensation from the anterior ⅔ of the tongue", "correct": false}, {"label": "D", "text": "Loss of tasteand sensation from the anterior ⅔ of the tongue", "correct": false}], "correct_answer": "B. Loss of sensation from the posterior ⅓ of the tongue", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/IzcNxZGm2Oc80ngQ2nt81745402786.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Development of tongue and nerve innervation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior ⅔ of tongue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior ⅓ of tongue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Posterior most of the tongue</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epithelial Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Two <span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\">lingual</span> swellings and a <span class=\"customMeta\" data-dictid=\"37a53c4c391692777201a13335f768\">tuberculum</span> impar, made from the <span class=\"customMeta\" data-dictid=\"cce38cfecb169277719201c34df7d6\">mesoderm</span> of 1st arch, <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> ⅔ of tongue.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"d3169c09a116927771893e69784932\">hypobranchial</span> <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> is formed by the <span class=\"customMeta\" data-dictid=\"cce38cfecb169277719201c34df7d6\">mesoderm</span> of the 3rd and 4th pharyngeal arches and is further divided into <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> and <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">caudal</span> parts. The <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> part of this <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> gives rise to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> ⅓.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\">Caudal</span> parts derived from the <span class=\"customMeta\" data-dictid=\"d3169c09a116927771893e69784932\">hypobranchial</span> <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">arch</span> develop to the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part of the tongue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Taste Sensation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chorda Tympani</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glossopharyngeal nerve (supplies <span class=\"customMeta\" data-dictid=\"70e388d8381692777184989a1e1127\">circumvallate</span> papillae)</p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Internal laryngeal nerve (Branch of Vagus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lingual nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Supply</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Except for the<strong> palatoglossus muscle,</strong> which is innervated by the <strong>vagus nerve</strong>, all other <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> and <span class=\"customMeta\" data-dictid=\"810de80cac1692777187a436b4315b\">extrinsic</span> muscles of the tongue are supplied by the <strong>hypoglossal nerve</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscles</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All the Tongue muscles develop from <strong>Occipital Somites.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your immediate course of action in managing a patient who is experiencing bleeding from the surgical site following a tonsillectomy while in the recovery room?", "options": [{"label": "A", "text": "Shift to OT, remove the clots, and cauterize/ligate the vessel", "correct": true}, {"label": "B", "text": "Shift to OT, start IV antibiotics, and pack the tonsillar fossa", "correct": false}, {"label": "C", "text": "Give anticoagulants, repeated gargling, and wait for 24 hours", "correct": false}, {"label": "D", "text": "Do blood transfusion and wait and watch", "correct": false}], "correct_answer": "A. Shift to OT, remove the clots, and cauterize/ligate the vessel", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Shift to OT, remove the clots, and cauterize/ligate the v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 56 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">